四肢开放性骨折术后闭合伤口湿润化管理的有效性分析

Effectiveness Analysis of Wetting Management of Closed Wound after Open Fracture of Limbs

摘要: 目的：四肢开放性骨折术后闭合伤口应用凡士林敷料湿润管理的疗效分析，为临床伤口管理提供证据。方法：选取2019年9月至2021年2月就诊于延安大学附属医院第一临床医学院创伤骨科的四肢开放性骨折并行清创术后患者100例，随机分为两组，湿润管理组使用碘伏棉球消毒后无菌凡士林纱布覆盖(1次/日)，对照组使用碘伏棉球消毒后普通无菌纱布覆盖(1次/日)，比较切口的愈合等级、感染率、渗出持续时间、瘢痕大小及患者切口疼痛评分分级。结果：湿润管理组切口的愈合等级较对照组好，差异有统计学意义(p = 0.0353)。湿润管理组的感染率(14%)低于对照组(32%)，差异有统计学意义(p = 0.0198)。术后切口的渗出持续时间上，湿润组较对照组短，且差异有统计学意义(湿润组：3.940 ± 2.377；对照组：7.180 ± 2.988；p < 0.05)。湿润组术后第3天VAS评分(2.060 ± 0.9348)低于对照组(3.580 ± 1.401)，且差异有统计学意义(p < 0.05)。VSS评分以及SCAR评分湿润组均低于对照组，且差异有统计学意义。(VSS评分：湿润组4.12 ± 1.023，对照组6.58 ± 1.797，p < 0.05；SCAR评分：湿润组6.606 ± 2.351，对照组7.420 ± 3.058，p < 0.05)。结论：湿性伤口管理相比于干燥环境有更好的愈合等级，更低的感染率，更短的愈合时间和疼痛时间，更少的瘢痕形成，在骨科清创术后闭合伤口护理中，更加推荐凡士林油纱的湿性管理。

Abstract: Objective: To analyze the therapeutic effect of vaseline dressing on closed wound after open fracture of limbs, and to provide evidence for clinical wound management. Methods: A total of 100 patients with open fractures of limbs and postoperative detrauma who were admitted to the Department of Orthopaedic Trauma, The First Clinical College of Affiliated Hospital of Yan’an University from September 2019 to February 2021 were randomly divided into two groups. The wetting management group was sterilized with iodophor cotton and covered with sterile vaseline gauze (once a day). The control group was covered with common sterile gauze after disinfection by iodophor cotton ball (once a day), and the incision healing grade, infection rate, exudation duration, scar size and incision pain score of patients were compared. Results: The incision healing grade of the moist management group was better than that of the control group, and the difference was statistically significant (P = 0.0353). The infection rate of wetting management group (14%) was lower than that of control group (32%), and the difference was statistically significant (P = 0.0198). The duration of exudation was shorter in the wetting group than in the control group, and the difference was statistically significant (wetting group: 3.940 ± 2.377; Control group: 7.180 ± 2.988; P < 0.05). VAS score of wetting group (2.060 ± 0.9348) was lower than that of control group (3.580 ± 1.401) on the third day after operation, and the difference was statistically significant (P < 0.05). VSS score and SCAR score in wetted group were lower than those in control group and the difference was statistically significant (VSS score: 4.12 ± 1.023 in wetting group and 6.58 ± 1.797 in control group, P < 0.05; SCAR score: 6.606 ± 2.351 in wetting group and 7.420 ± 3.058 in control group, P < 0.05). Conclusion: Compared with dry wound management, wet wound management has better healing grade, lower infection rate, shorter healing time and pain time, and less scar formation. Vaseline gauze wet management is more recommended in closed wound care after orthopaedic debridement.