Application of external fixator combined with vacuum sealing drainage for limbs’ open fracture with severe soft tissue injuries

doi:10.3969/j.issn.2095-4344.2014.44.019

Abstract

Abstract:

BACKGROUND: The treatment of limbs’ open fracture with severe soft tissue injury is very complicated. There are many wound exudates, high frequency of dressing change, and high infection rate. How to deal with the contradiction between wound treatment and fracture fixation is the considerable problem in clinical therapy.
OBJECTIVE: To explore the effect of external fixator combined with vacuum sealing drainage on limbs’ open fracture with severe soft tissue injuries.
METHODS: A total of 34 patients with limbs’ open fracture with severe soft tissue injuries were enrolled in the First Affiliated Hospital, Xinxiang Medical College from December 2009 to December 2010. There were 20 males and 14 females, with an average age of 36.6 years old. There were 10 cases of upper limb fracture and 24 cases of lower limb fracture. After debridement, cutaneous deficiency accounted for 1% to 6% of surface area. On the basis of external fixation, the wound received vacuum sealing drainage (treatment group; n=17) and conventional dressing (control group; n=17). According to limb swelling and granulation growth, delayed suture, skin graft or flap to cover the wound were used. After treatment, infection rate of the wound and growth of granulation were observed. In accordance with wound healing and growth of granulation, curative effects were evaluated.
RESULTS AND CONCLUSION: In the treatment group, there were 11 cases of healing, 5 cases of effective effects, and 1 case of ineffective effect, with a total effective rate of 94% and the infection rate of about 15%. In the control group, there were 7 cases of healing, 6 cases of effective effects, and 4 cases of ineffective effects, with a total effective rate of 76% and the infection rate of about 40%. Significant differences in healing rate, total effective rate and infection rate were detected between the two groups (P < 0.05). The healing time of wound was 8.66-16.23 days in the treatment group and 15.68-22.36 days in the control group. The healing time was significantly shorter in the treatment group than in the control group (P < 0.05). It is thus clear that vacuum sealing drainage has obvious advantages in repair of limbs’ open fracture with severe soft tissue injury compared with the conventional dressing.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: fractures, open, negative-pressure wound therapy, external fixators

CLC Number:

R318

Liu Shen-peng, Wan Guang, Liang Qiu-dong, Duan Yong-zhuang, Xu Hai-bin. Application of external fixator combined with vacuum sealing drainage for limbs’ open fracture with severe soft tissue injuries[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(44): 7157-7161.

Figures/Tables 1

References

[1]朱剑.单侧多功能外固定支架治疗胫腓骨骨折的临床研究[D].苏州大学.2004.
[2]宋社庭.桡骨远端不稳定性骨折组合式外固定支架治疗临床探析[J].中外医学研究,2014,18:41-42,43.
[3]Arora R, Lutz M, Hennerbichler A, et al.Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate.J Orthop Trauma.2007;21(5):316-322.
[4]Figl M, Weninger P, Jurkowitsch J, et al.Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction.J Trauma. 2010; 68(4):992-998.
[5]Hossain E, Dugar N, Garg AK, et al.Comparative results of treatment of open diaphyseal fractures of tibia by the use of commonly used external fixators.J Indian Med Assoc. 2013; 111(12):830-832
[6]Milenkovi? S, Mitkovi? M, Mici? I, et al.Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method.Vojnosanit Pregl. 2013;70(9):836-841.
[7]Ye T, Chen A, Yuan W, et al.Management of grade III open dislocated ankle fractures: combined internal fixation with bioabsorbable screws/rods and external fixation.J Am Podiatr Med Assoc. 2011;101(4):307-315.
[8]李建飞,黄巧玲.治疗骨科创伤及感染创面的临床疗效观察[J].实用临床医学,2009,10(7):51252.
[9]张向阳,胡雁,胡斌,等.VSD 在不完全皮肤撕脱伤修复中的应用探讨[J].生物医学工程与临床,2010,14(5):424-426.
[10]张希彦,左伟,蔺攀, 等.持续封闭负压引流技术在开放骨折软组织缺损时的应用[J].医药论坛杂志,2010,31(19):87-88.
[11]张建,吴克俭,王刚,等.持续负压封闭吸引在晚期大面积皮肤撕脱伤合并感染中的应用[J].中国修复重建外科杂志, 2009,23(10): 1170-1172.
[12]赵继宏,方昕.负压封闭引流及皮片移植修复胫腓骨骨折的皮肤软组织缺损[J]. 中国组织工程研究,2014,18(20):3246-3251.
[13]杨瑞增,张文明.负压封闭引流加外固定架治疗胫腓骨开放性骨折感染创面[J].临床骨科杂志,2011,14(3):289-290.
[14]龙显斌,贺常仁,刘芳,等.负压封闭引流联合内外固定治疗胫腓骨开放骨折[J].实用骨科杂志,2010,16(8):620-623.
[15]杜海龙,何纯青,柳现飞,等.外固定支架结合负压封闭引流技术治疗Gustilo Ⅲ型胫腓骨开放性骨折[J].中华创伤骨科杂志,2011, 13(5):433-436.
[16]郑群燕.负压封闭引流联合外固定支架治疗胫腓骨开放性骨折的护理[J].解放军护理杂志,2010,27(17):1331-1332.
[17]许鹏雍,凌尚准,陈俊,等.外固定架结合封闭式负压引流治疗软组织缺损胫骨粉碎性骨折[J].中国矫形外科杂志,2010,18(12): 1055-1055.
[18]蔡义红.负压封闭引流联合内外固定治疗胫腓骨开放性骨折的护理[J].实用临床医药杂志,2011,15(12):60-62.
[19]李健卿.外固定支架加封闭式负压吸引治疗胫腓骨骨折40例疗效观察[J].海南医学,2010,21(17):75-76.
[20]竺亚,曹进,胡珊珊.外固定架联合密闭负压引流术治疗儿童严重开放性骨折的护理[J].中医正骨,2010,22(6):79-80.
[21]黄晖,刘世清,张驽,等.外固定支架联合负压封闭引流技术治疗胫腓骨开放性骨折20例分析[J].中国误诊学杂志,2011,11(1):216.
[22]刘涛,张弢,赵虬,等.负压封闭引流结合外固定架一期治疗重度开放损伤软组织缺损[J].中国矫形外科杂志,2011,19(6):511-512.
[23]杨顺云,黎云冲.外固定支架治疗四肢严重开放性骨折的临床体会[J]中华医学实践杂志,2006,5(11):12521.
[24]罗伟,张兴泰,祝仁兵.四肢严重创伤联用外支架与封闭负压引流早期观察[J].吉林医学,2010,31(23):3811-3812.
[25]丁凡,邵增务,吴宏斌.外固定器结合封闭负压引流技术治疗胫腓骨骨折术后感染[J].中国矫形外科杂志,2010,18(8):645-648.
[26]郑旭.VSD治疗25例骨科创伤感染临床疗效分析[J].四川医学, 2010,31(8):1102-1103.
[27]王昆.地震后四肢开放伤口的治疗策略[J].中山大学学报,2008, 29(5):21.
[28]单乐群,马保安,周勇,等.地震后送骨科伤员开放创面的治疗分析[J].中国现代手术学杂志,2010,14(3):196-198.