【摘要】 目的 观察胫腓骨骨折合并骨筋膜室综合征(()CS)患者应用手术切开复位且内固定后,辅助常规引流包扎敷贴覆盖、负压封闭引流技术和DR脱细胞异种皮三类伤口处置技术治疗的临床效果。方法 筛选67例胫腓骨骨折合并OCS患者的临床资料,根据创面伤口处理方法的不同分为A、B、C 3组。A组患者32例,经皮肤切开直视复位和内固定术后采用凡士林纱布覆盖创面治疗;B组患者18例,经皮肤切开直视复位和内固定后采用负压封闭引流技术治疗;C组患者13例,经皮肤切开直视复位和内固定后采用DR脱细胞异种(猪)皮覆盖治疗。所有患者至伤口软组织恢复后,再行二次手术游离植皮肤修复。观察术后不同时间3组患者的伤口感染情况、创面渗液量以及疼痛情况、小腿周径,以及患者的住院时间、换药次数和二期创面修复时间。结果 A组第4、7、10天伤口感染率分别为15.6%(5/32)、18.8%(6/32)、25.0%(8/32),B组未见细菌培养阳性患者,C组于第10天有1例(7.7%)细菌培养阳性;B、C组术后伤口感染率明显低于A组,差异有统计学意义(P<0.05)。A组术后1、2、3 d创面渗液量均明显多于B、C组[术后1 d:(516±57)ml比(196±37)、(464±59)ml;术后2 d:(502±62)ml比(142±31)、(388±40)ml,术后3 d:(372±51)ml比(77±31)、(291±51)ml],并且B组渗液量明显少于C组,差异均有统计学意义(均P<0.05)。A、B、C 3组术后1、4、7 d疼痛评分差异均有统计学意义[术后1 d:(8.17±0.52)、(0.91±0.35)、(5.89±0.51)分;术后4 d:(8.81±0.39)、(0.75±0.26)、(5.67±0.43)分;术后7 d:(8.63±0.47)、(0.74±0.33)、(5.46±0.47)分;均P<0.05]。术后2、4、6、8、10、12、14 d,B组小腿周径均低于A、C组[分别为:(3.09±0.74)cm比(6.96±0.52)、(5.72±0.48)cm,(3.56±0.48)cm比(8.27±0.47)、(6.72±0.51)cm,(3.43±0.42)cm比(8.32±0.46)、(6.27±0.39)cm,(2.41±0.35)cm比(5.27±0.42)、(3.15土0.41)cm,(1.87±0.44)cm比(4.22±0.34)、(2.78±0.51)cm,(0.68±0.11)cm比(2.59±0.31)、(2.09±0.18)cm,(0.01±0.08)cm比(0.12±0.11)、(0.08±0.04)cm],差异均有统计学意义(均P<0.05)。伤后2、4、6、8、10 d,C组小腿周径均明显低于A组,差异均有统计学意义(均P<0.05)。A、B、C 3组住院时间、换药次数、二期创面修复时间比较,差异均有统计学意义[分别为:(32±9)、(22±7)、(29±5)d,(13.8±5.3)、(2.6±0.5)、(7.6±2.7)次,(10.7±5.1)、(5.3±2.3)、(7.7±5.1)d,均P<0.05]。结论 直视复位结合内固定术后,负压封闭引流技术治疗胫腓骨骨折合并OCS可减少治疗住院时间,减少伤口感染率和创面渗液量,避免过度肿胀和减轻疼痛。DR脱细胞异种皮治疗效果不及负压封闭引流技术,但适合经济困难患者选用。更多还原

【Abstract】 Objective To observe the clinical effects of conventional drainage bandage wrap cover,vacuum sealing drainage and DR leather on the wound of tibia and fibula fracture with compartment syndrome(OCS)treated with open reduction and internal fixation surgery.Methods All 67 cases of tibia and fibula fracture with OCS were screened.All patients were divided into three groups according to the methods of wound treatment.The patients in group A(32 cases) were treated with a conventional drainage;group B(18 cases) were treated with vacuum sealing drainage and group C(13 cases) received DR Xenogenic leather cover.The wound infection,wound exudation,pain score,calf circumference,the hospitalization time,the times of dressing changes and two phase wound repair time after operation were compared among three groups.Results The infection rates of wound in group B and C were significandy lower than those in group A(P<0.05).The wound exudation 1,2,3 day after operation in group A was more than that in group B and C[1 d postoperation:(516±57) ml vs(196±37),(464±59)ml;2 d postoperation:(502±62) ml vs(142±31),(388±40) ml;3 d postoperation:(372±51) ml vs(77±31),(291±51)ml];the wound exudation in group B was significantly less than that in group C,(all P <0.05).There were significant differences of pain score 1,4,7 d after operation among A,B and C groups[1 d postoperation:(8.17±0.52),(0.91±0.35),(5.89±0.51) scores;4 d postoperation:(8.81±0.39),(0.75±0.26),(5.67±0.43)scores;7 d postoperation:(8.63±0.47),(0.74±0.33),(5.46±0.47)scores;all P <0.05].The calf circumferences in group B was less than that in group A and C 2,4,6,8,10,12,14 d after operation[(3.09±0.74) cm vs(6.96±0.52),(5.72±0.48) cm;(3.56±0.48)cm vs(8.27±0.47),(6.72±0.51)cm;(3.43±0.42) cm vs(8.32±0.46),(6.27±0.39) cm;(2.41±0.35) cm vs(5.27±0.42),(3.15±0.41)cm;(1.87±0.44) cm vs(4.22±0.34),(2.78±0.51)cm;(0.68±0.l)cm vs(2.59±0.31),(2.09±0.18)cm;(0.01±0.08)cm vs(0.12±0.11),(0.08±0.04)cm,respectively];the calf circumferences in group C was significandy less than that in group A 2,4,6,8,10 d after operation(all P<0.05).The hospitalization time,the times of dressing changes and two phase wound repair time among group A,B and C were significandy different[(32±9),(22±7),(29±5)d;(13.8±5.3),(2.6±0.5),(7.6±2.7);(10.7±5.1),(5.3±2.3),(7.7±5.1)d,all P<0.05].Conclusion The vacuum sealing drainage on wound of patients with tibia and fibula fractures combined with OCS can reduce the hospitalization time and the rate of infection;it can avoid excessive swelling and relieve pain.更多还原