Clinical effect of negative pressure wound therapy in emergency limb-salvage operation of destructive injury of limb
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摘要: 目的 探讨负压伤口疗法(NPWT)在肢体毁损伤急诊保肢手术中临床的作用。 方法 2014年7月—2017年12月,笔者单位收治43例符合入选标准的单侧肢体毁损伤患者,按照不同治疗方法将患者分为NPWT组24例[男21例、女3例,年龄(38±10)岁]和常规换药组19例[男17例、女2例,年龄(37±10)岁]。急诊行清创、骨折外固定、血管神经探查、显微外科修复术后,NPWT组患者行NPWT治疗,常规换药组行常规换药治疗。急诊术后7~10 d,计算2组患者动脉栓塞率并观察创面感染情况。统计2组患者创面完全愈合时间和肢体存活情况。对数据行独立样本
t 检验、χ 2检验。 结果 急诊术后7~10 d,NPWT组患者动脉栓塞率为6.67%(3/45),与常规换药组患者的5.56%(2/36)相近(χ 2=0.043,P >0.05)。急诊术后7~10 d,NPWT组1例患者创面感染,明显少于常规换药组6例,χ 2=5.847,P <0.05。NPWT组患者创面完全愈合时间为(30±4)d,明显短于常规换药组的(36±8)d,t =2.813,P <0.01。NPWT组24例患者肢体存活,与常规换药组的18例相近(χ 2=1.293,P >0.05)。 结论 NPWT治疗可明显降低毁损肢体急诊术后创面感染率、缩短创面愈合时间,值得临床推广应用。Abstract: Objective To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent samplet test or chi-square test. Results Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ 2=0.043,P >0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ 2=5.847,P <0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t =2.813,P <0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ 2=1.293,P >0.05). Conclusions NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.
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