目的 观察跨关节外固定支架联合负压封闭引流(VSD)技术应用于急诊四肢软组织损伤伴骨折患者的疗效.方法 回顾性分析河北中石油中心医院急诊科2020年3月—2022年3月期间收治的四肢软组织损伤伴骨折患者90例,男性49例,女性41例;年龄18～63岁,平均39.7岁;致伤原因:高处坠落伤15例,道路交通伤24例,重物砸伤20例,机械轧伤17例,其他14例;受伤部位:下肢26例,足部25例,踝部24例,其他15例;标准Gustilo分型:Ⅱ型40例,Ⅲ型50例;骨折类型:粉碎性17例,横断型13例,长斜型16例,螺旋型22例,其他22例.按照治疗方法将患者分为A组(43例)和B组(47例).A组患者接受跨关节外固定支架联合常规清创换药治疗,B组患者接受跨关节外固定支架联合VSD治疗.对比两组疗效、临床指标、并发症发生率,同时对比两组治疗前、治疗6个月后的炎症因子水平.结果B组(93.6％,44/47)临床总有效率高于A组(67.4％,29/43),P＜0.05.两组手术时间[A组:(68.8±5.6)min;B组:(67.1±4.4)min]比较差异无统计学意义(P＞0.05).B组住院时间(15.6±1.9)d、创面愈合时间(13.1±2.1)d、清创时间(41.8±7.6)min、骨折愈合时间(91.1±7.1)d 均短于 A 组[(25.8±2.3)d、(22.9±2.0)d、(54.6±5.7)min、(103.1±9.2)d],换药次数(2.9±0.8)次少于A组(6.9±1.1)次,创面感染发生率(4.4％)低于A组(20.0％),差异均有统计学意义(P均＜0.05).B组治疗6个月后hs-CRP(8.4±2.1)mg/L、IL-6(18.2±2.5)pg/mL、IL-8(23.3±3.1)pg/mL 低于 A 组[(13.5±3.8)mg/L、(24.4±4.8)pg/mL、(32.9±5.7)pg/mL],IL-10(37.5±3.9)pg/mL高于A组[(29.4±3.7)pg/mL,P＜0.05].B组术后感染、皮肤移植物移位、积液、血肿等并发症总发生率为4.2％(2/47),低于A组的14.0％(6/43),差异有统计学意义(P＜0.05).结论 跨关节外固定支架联合VSD应用于急诊四肢软组织损伤伴骨折患者,可提高治疗效果,促进骨折愈合;同时可有效调节炎性因子水平,降低并发症发生率.
Clinical effect of cross-joint external fixation bracket combined with vacuum sealing drainage in emergency treatment of fracture patients with limb soft tissue injuries
Objective To observe the efficacy of cross joint external fixation bracket combined with vacuum sealing drainage(VSD)in emergency management of fracture patients with limb soft tissue injuries.Methods Al-together 90 patients with fractures and limb soft tissue injuries who were admitted to the Department of Emergency of Heibei Petro China Center Hospital from Mar.2020 to Mar.2022 were retrospectively selected,including 49 males and 41 females aged 18-63(mean 39.7)years.The injury causes were falls from height in 15,road traffic injuries in 24,hit by heavy objects in 20,machine crushing in 17,and others in 14.Among them,26 injured the lower limbs,25 the feet,24 the ankles,and 15 other areas.Based on Gustilo classification,there were 40 cases of type Ⅱand 50 type Ⅲ,with 17 comminuted fractures,13 transverse fractures,16 long oblique fractures,22 spiral fractures,and 22 others.According to the treatment methods,patients were divided into group A(n=43,cross-joint external fixation bracket±routine debridement and dressing change)and group B(n=47,cross-joint external fixation bracket+VSD).The treatment outcomes,clinical indicators,and incidence of complications were compared between the two groups.At the same time,the levels of inflammatory factors before and 6 months after treatment were compared.Results There was no significant difference in operation time between groups A and B(min,68.8±5.6 vs.67.1±4.4,P＞0.05).The total clinical effective rate in group B(93.6％,44/47)was higher than that in group A(67.4％,29/43,P＜0.05),together with much shorter hospitalization time(d,15.6±1.9 vs.25.8±2.3),wound healing time(d,13.1±2.1 vs.22.9±2.0),debridement time(min,41.8±7.6 vs.54.6±5.7)and fracture healing time(d,91.1±7.1 vs.103.1±9.2),and much less frequency of dressing change(2.9±0.8 vs.6.9±1.1)and in-cidence of wound infection(4.4％vs.20.0％,all P＜0.05 compared with group A).At 6 months after treatment,the infection indicators showed much lower levels of high-sensitivity C-reactive protein(mg/L,8.4±2.1 vs.13.5±3.8),interleukin(IL)-6(pg/mL,18.2±2.5 vs.24.4±4.8),and IL-8(pg/mL,23.3±3.1 vs.32.9±5.7)in group B than in group A and much higher levels of IL-10(pg/mL,37.5±3.9 vs.29.4±3.7,all P＜0.05).The to-tal incidence of postoperative complications such as infection,skin graft displacement,fluid accumulation,and hema-toma in group B was 4.2％(2/47),significantly lower than the 14.0％(6/43)in group A(P＜0.05).Conclusion The application of the cross-joint external fixation bracket combined with VSD in emergency management of frac-ture patients with limb soft tissue injuries can improve the therapeutic effect,promote fracture healing,and simultane-ously reduce infection and other complications.
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