清创后负压辅助肢体创面闭合与常规治疗的比较△

Vacuum-assisted closure versus conventional dressing change for limb wound after debridement

摘要:

［目的］ 评价清创联合负压辅助创面闭合在治疗肢体创面的临床效果。［方法］ 回顾性分析 2017 年 10 月—2019 年 11 月本院收治的骨科肢体创面 64 例患者的临床资料。依据术前医患沟通结果，32 例采用清创联合负压辅助创面闭合治疗 （VAC 组），32 例采用清创联合常规创面换药治疗（常规组）。比较两组围手术期、随访与检验结果。［结果］两组均顺利完成二期手术，术中无严重并发症。VAC 组初次手术时间长于常规组，但差异无统计学意义（P>0.05），VAC 组换药次数、渗出评级、 肉芽评级、两次手术间隔时间、二次手术时间、创面愈合情况、住院时间等均显著优于常规组（P<0.05）。VAC 组的完全负重活动时间显著早于常规组（P<0.05）。随时间推移，两组 VAS 评分、局部瘢痕情况、邻近关节功能均显著改善（P<0.05）。术后 3 个月 VAC 组上述指标显著优于常规组（P<0.05）。术后 6、12 个月两组上述指标的差异均无统计学意义（P>0.05）。实验室检查方面，随时间推移，两组 WBC、NEU、CRP 和 ESR 均显著下降 （P<0.05）。二次术前 VAC 组上述指标均显著优于常规组 （P< 0.05）。［结论］与常规换药相比，负压辅助创面闭合具有缩短创面康复时间，降低感染风险和并发症发生率的优点。

Abstract:

[Objective] To evaluate the clinical efficacy of debridement combined with vacuum-assisted closure (VAC) for limb wound. [Methods] A retrospective study was performed on 64 patients who received surgical treatment of limb wound in our hospital from October 2017 to November 2019. According to the consequence of preoperative doctor-patient communication, 32 patients were treated with debride- ment combined with VAC (the VAC group) , while the remaining 32 patients were treated with debridement combined with conventional dressing change (the conventional group) . The documents regarding to perioperative period, follow-up and laboratory tests were compared between the two groups. [Results] All patients in both groups had the two-stage operations performed successfully without serious complica- tions. The VAC group consumed slight longer operation time in the first stage than the conventional group, but without a statistically signifi- cant difference between them (P＞0.05) . The VAC group proved significantly superior to the conventional group in terms of number of dress- ing change, exudation grade, granulation grade, interval between two operations, time of the second operation, wound healing and hospital stay (P＜0.05) . In addition, the VAC group resumed full weight-bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS scores, local scar, and adjacent joint function improved significantly over time in both groups (P＜0.05) , which in the VAC group was significantly superior to the conventional group at 3 months postoperatively (P＜0.05) , whereas became not statistically significant be- tween the two groups at 6 and 12 months postoperatively (P＞0.05) . With respect of laboratory tests, the WBC, NEU, CRP, and ESR de- creased significantly over time in both groups (P＜0.05) , which in the VAC group were significantly better than those in conventional group before the second stage operation (P＜0.05) . [Conclusion] The VAC has advantages of shortening recovery time of limb wound, reducing the risk of infection and the incidence of complications over the conventional dressing change.