北京生物醫(yī)學(xué)工程

封閉負(fù)壓引流對脛骨平臺骨折內(nèi)固定術(shù)后感染處理的臨床效果研究

Clinical effect of vacuum sealing drainage treatment on postoperative infection after internal fixation of tibial plateau fractures

作者：張叢笑王豫劉德全楊明連劉新房魏更生吳京亮左如俊

單位：北京海淀醫(yī)院骨科(北京100080)

關(guān)鍵詞：封閉負(fù)壓引流脛骨平臺骨折術(shù)后感染內(nèi)固定

分類號：

出版年·卷·期（頁碼）：2012·31·4（411-414）

摘要：

目的脛骨平臺骨折常伴隨軟組織嚴(yán)重?fù)p傷，因此術(shù)后多發(fā)感染。封閉負(fù)壓引流(vacuum sealing drainage, VSD)通過在創(chuàng)面形成持續(xù)負(fù)壓產(chǎn)生的機(jī)械學(xué)和生物學(xué)效應(yīng)可有效促進(jìn)創(chuàng)面愈合。本文通過臨床實驗對比研究，探討封閉負(fù)壓引流術(shù)對脛骨平臺骨折內(nèi)固定術(shù)術(shù)后感染處理的臨床效果。方法對28例脛骨平臺骨折內(nèi)固定病例進(jìn)行術(shù)后跟蹤，其中16例發(fā)生術(shù)后感染，獲得感染率及不同病原菌占比數(shù)據(jù)。之后以VSD處理的病例為實驗組，以反復(fù)清創(chuàng)配合碘伏紗布縫合處理的病例為對照組，通過長期隨訪對兩種方法的臨床效果進(jìn)行對比分析。結(jié)果 VSD組8例患者術(shù)后恢復(fù)時間的統(tǒng)計結(jié)果為(12.5±5.15) 月，反復(fù)清創(chuàng)組8例患者術(shù)后恢復(fù)時間的統(tǒng)計結(jié)果為(13.6±5.94)月。結(jié)論對Schatzker Ⅴ、Schatzker Ⅵ型術(shù)后感染率較高的脛骨平臺骨折，兩種術(shù)后處理方法均可獲得較好的治療效果。

Objective The postoperative infection rate of tibial plateau fractures is high since severe soft tissue injuries always come along with tibial plateau fractures. Vacuum sealing drainage (VSD) can accelerate wound healing through the mechanics and the biological effects of continuous negative pressure. The clinical effect of VSD treatment is investigated through clinical experiments. Methods Twenty-eight cases of internal fixation of tibial plateau fractures were studied to get the postoperative infection rate and the percentage of different pathogens. Then the clinical results of two different approaches were compared, one was VSD method and the other was repeated debridement and iodophor gauze suturing. Results The healing time of VSD group was (12.50±5.15) months (n=8) and that of the control group was (13.60±5.94) months (n=8). Conclusions The two approaches could achieve the equal clinical results for the postoperative infection treatment oftype V and VI fractures in Schatzker classification.

參考文獻(xiàn)：

［1］Barei DP，Nork SE，Mills WJ，et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique［J］. J Orthop Trauma，2004，18(10):649.
［2］Schatzker J, McBroom R, Bruce D. The tibial plateau fracture ［J］. Cline Orthop, 1979, (138):94-104.
［3］Lachiewic ZP, Funcik T. Factions influencing the results of open reduction and internal fixation of tibial plateau fracture ［J］.Clin Orthop,1990,(259): 210.
［4］顧龍殿，何家文，吳良浩，等．雙側(cè)鋼板治療復(fù)雜脛骨平臺骨折療效分析［J］．中國骨與關(guān)節(jié)損傷雜志，2006，21（3）：185.
Gu Longdian, He Jiawen, Wu Lianghao, et al. Analysis of curative effect of complicated tibial plateau fractures with open reduction and internal fixation with bilateral plates［J］.Chinese Journal of Bone and Joint Injury, 2006，21（3）：185
［5］Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures［J］. Orthop Rev, 1994, 23(2): 149.
［6］Fleischmann W，Strecker W，Bombelli M，et al．Vacuum sealing as treatment of soft tissue damage in open fractures［J］．Unfallchirurg，1993，96( 9) : 488-492.
［7］Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities［J］. Injury, 2012, 43(6):822-828.
［8］Tang J, Guo WC, Yu L, et al. Clinical efficacy of artificial skin combined with vacuum sealing drainage in treating large-area skin defects. Chinese Journal of Traumatology (English Edition), 2010, 13(5):289-292.
［9］Petzina R, Gustafsson L, Mokhtari A, et al. Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall afterinternal mammary artery harvesting［J］. Eur J Cardiothorac Surg, 2006, 30(1): 85-89.
［10］Chen SZ, Li J, Lin XY. Effects of vacuum-assisted closure on wound microcirculation: an experimantal study［J］. Asian J Surg, 2005, 28(3):211-217.
［11］Ladwig GP, Robson MC, Liu R, et al. Rations of activated MMP-9/TIMP-1 in wound fluids are inverse correlated with healing of pressure ulscers［J］. Wound Repaire Regen, 2002, 10(10): 26-37.
［12］石冰，陳紹宗，張萍，等．封閉負(fù)壓引流技術(shù)對人肉芽創(chuàng)面中MMP-1、MMP-2、MMP-13mRNA表達(dá)的影響［J］．中華整形外科雜志，2003, 19(4):279-281.
Shi Bing, Chen Shaozong, Zhang Ping, et al. Effects of vacuum-assisted closure (VAC) on the expressions of MMP-1, 2, 13 in human granulation wound［J］. Chinese Journal of Plastic Surgery and Burns, 2003, 19(4):279-281.
［13］Nakazawa T, Yasuhara H, Shigematsu K, et al. Smooth muscle cell migration induced by shear-loaded platelets and endothelial cells， Enhanced PDGF production by shear-loaded platelets ［J］. Int angiol, 2000, 19(2): 142-146.
［14］Kilpadi D, Bower CE, Reade CC. Effect of vacuum-assisted closure therapy on early systemic cytokine levels in a swine model ［J］. Wound Rep Reg, 2006, 14(2):210-215.
［15］Younan G, Ogawa R, Ramirez M, et al. Analysis of nerve and neuropeptide patterns in vacuum-assisted closure treated diabetic murine wound ［J］. Plastic Reconstr Surg, 2010, 126(1):87-96

服務(wù)與反饋：

【文章下載】【加入收藏】

提示：您還未登錄，請登錄！點(diǎn)此登錄

51黑料吃瓜在线观看,51黑料官网|51黑料捷克街头搭讪_51黑料入口最新视频