真空负压封闭引流结合外固定支架治疗小腿骨折并骨筋膜室综合征21例疗效观察

The Effective of 21 Lower Leg Fracture with Osteofascial Compartment Syndrome Treated by Vacuum Sealing Drainage Combined with External Fixation

摘要: 目的：探讨负压封闭引流结合外固定支架治疗小腿骨折并骨筋膜室综合征的临床疗效。方法：36例小腿骨折并骨筋膜室综合征患者，行筋膜室切开减压，骨折行有限内固定并外固定支架固定，创面随机分为负压组和纱布换药组，21例创面行负压封闭引流技术处理，15例行无菌纱布棉垫包扎，肿胀消退后创面直接缝合或者行植皮术，术后观察创面引流量及创面愈合时间，通过随访按照Johner-Wruhs胫骨干疗效评价标准评定小腿功能恢复情况。结果：患者经过7月~3年随访(平均18.2月)，术后平均引流量纱布换药组约180.5 ml，负压组约240.2 ml (P < 0.05)；创面愈合时间纱布换药组19.3天，负压组15.6天(P < 0.05)；负压组发生浅表感染3例，针孔感染2例，平均骨折愈合时间8.6月。按Johner-Wruhs胫骨干疗效评价标准评定功能恢复情况：优27例，良6例，差3例，优良率91.7%。结论：负压封闭引流结合外固定支架治疗小腿骨折合并骨筋膜综合症，手术操作简单，疗效确切，可在基层医院广泛开展。

Abstract: Objective: To investigate the clinical efficacy of vacuum sealing drainage combined with external fixation in the treatment of lower leg fracture and osteofascial compartment syndrome. Method: 36 patients of lower leg fracture with osteofascial compartment syndrome, all osteofascial compart- ment open decompression, fractures were treated with limited internal fixation and external fixation. Wounds were divided into Vacuum sealing drainage group and gauze dressing group randomly. 21 patients with vacuum sealing drainage technique and 15 patients dressed with sterile gauze pad, give wound suture or skin grafting after the swelling subsids and postoperative wound drainage and healing time are observed. The patients were followed-up according to Johner-Wruhs tibial curative effect evaluation standard of lower leg function recovery. Results: All patients were followed by 7 months to 3 years (average 18.2 months). The average postoperative drainage gauze group was about 180.5 ml, vacuum sealing drainage group was about 240.2 ml (P < 0.05), wound healing time gauze group was 19.3 days, the negative pressure drainage group was 15.6 days (P < 0.05). Vacuum sealing drainage group had superficial infection in 3 cases, 2 cases of pinhole infection, the average healing time was 8.6 months. According to the Johner-Wruhs tibia curative effect evaluation standard of leg function recovery, 27 cases were excellent, 6 cases were good, 3 cases were poor, the excellent and good rate was 91.7%. Conclusion: Vacuum sealing drainage combined with external fixation in the treatment of lower leg fracture complicated with osteofascial compartment syndrome is simple to operate and effective, which can be widely carried out in the primary hospitals.