Objective  To investigate the mechanism of combined application of vacuum sealing drainage (VSD) and external fixator and its application value in the treatment of fracture infec-tion in extremities.

Methods  96 patients with limb fracture admitted to Zhengzhou Orthopedics Hospital were divided into CT group and CX group with 48 cases in each group using random number table method, all of which were treated with external fixation for limb fracture with infection. In the treatment of postoperative incision infection, traditional continuous perfusion irrigation intervention was performed in the CT group, and VSD intervention was performed in the CX group. Serum inflam-matory factors (CRP, IL-6, TNF-α) and wound healing factors (aFGF, bFGF, TGF-β) were detected be-fore and after intervention, and wound healing time was calculated to evaluate clinical prognosis.

Results  After intervention, serum CRP, IL-6 and TNF-α in CX group were lower than those in CT group (P<0.05), and serum aFGF, bFGF and TGF-β were higher than those in CT group (P<0.05). The mean wound healing time in CX group was shorter than that in CT group (18.24±1.12 vs. 32.43±4.45, P=0.009). The total incidence of adverse prognostic events such as fat liquefaction of surgical incision, local skin tissue necrosis, osteomyelitis, and poor fracture healing in CX group was lower than that in CT group (6.25% vs. 18.75%).

Conclusion  VSD intervention on the incision after external fixation can effectively improve the inflammatory response of the body, improve the wound healing effect, and reduce the incidence of postoperative incision infection complications in patients with limb fracture with infection.

1.李炜, 邱盛强, 罗斌, 等. 四肢骨折内固定术后切口感染病原菌特点及血清炎症因子水平[J]. 中国预防医学杂志, 2020, 21(11): 1226-1230. [Li W, Qiu SQ, Luo B, et al. Etiological characteristics of incision infection and serum inflammatory cytokine levels in patients with limb fractures after internal fixation surgery[J]. China Preventive Medicine, 2020, 21(11): 1226-1230.] DOI: 10.16506/j.1009-6639.2020.11.014.

2.刘鹏, 王伟. 老年开放性胫骨骨折患者行VSD联合外固定术对营养、心理及生存质量的影响[J]. 中国老年学杂志, 2022, 42(4): 848-852. [Liu P, Wang W. Effects of VSD combined with external fixation on nutrition, psychology and quality of life in elderly patients with open tibial fracture[J]. Chinese Journal of Gerontology, 2022, 42(4): 848-852.] DOI: 10.3969/j.issn.1005-9202.2022.04.024.

3.徐袁丁, 董训忠, 宋晓红, 等. 伤口评估三角联合负压封闭引流技术在慢性难愈性创面治疗中的应用[J]. 护理研究, 2021, 35(14): 2582-2584. [Xu YD,  Dong XZ, Song XH, et al. Application of wounds international combined with vacuum sealing drain-age in treatment of chronic refractory wound[J]. Chinese Nursing Research, 2021, 35(14): 2582-2584.] DOI: 10.12102/j.issn.1009-6493.2021.14.027.

4.李宏元, 王亮. 刚性或柔性外固定器诱导小鼠骨折处愈合组织形成的效果及稳定性比较[J]. 中国组织工程研究, 2019, 23(28): 4510-4515. [Li HY, Wang L. Comparison of the effect and stability of rigid or flexible external fixator in inducing healing tissue formation at fracture site in mice[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4510-4515.] DOI: 10.3969/j.issn.2095-4344.1452.

5.赵旭. VSD配合灌注冲洗方案对四肢骨折内固定术后感染及创面愈合的影响[J]. 中国现代药物应用, 2022, 16(23): 42-44. [Zhao X. Effect of VSD combined with perfusion irrigation on infection and wound healing after internal fixation of extremities fractures[J]. Chinese Journal of Modern Drug Application, 2022, 16(23): 42-44.]DOI: 10.14164/j.cnki.cn11-5581/r.2022.23.011.

6.袁情, 杨重飞, 贾瑛, 等. 清创术后持续灌洗联合VSD治疗胫腓骨开放性骨折术后感染的效果观察[J]. 临床误诊误治, 2020, 33(12): 70-74. [Yuan Q, Yang CF, Jia Y, et al. Observation on the effect of continuous lavage after debridement combined with vsd in the treatment of postoperative infection of open tibia and fibula fractures[J]. Clinical Misdiagnosis & Mistherapy, 2020, 33(12): 70-74.] DOI: 10.3969/j.issn.1002-3429.2020.12.017.

7.赵建武, 魏建江. 外固定器结合封闭负压引流术治疗四肢骨关节严重开放性骨折的临床效果研究[J]. 检验医学与临床, 2022, 19(3): 391-393. [Zhao JW, Wei JJ. Clinical effect of external fixator combined with closed negative pressure drainage in the treatment of severe open fracture of extremities and joints[J]. Laboratory Medicine and Clinic, 2022, 19(3): 391-393.] DOI: 10.3969/j.issn.1672-9455.2022.03.028.

8.李红普, 王兵, 尚文煊. 富血小板血浆联合负压封闭引流治疗慢性难愈性创面的疗效[J]. 郑州大学学报(医学版), 2021, 56(4): 560-563. [Li HP, Wang B, Shang WX. Efficacy of platelet-rich plasma combined with vacuum sealing drainage for chronic refractory wounds[J]. Journal of Zhengzhou University(Medical Sciences), 2021, 56(4): 560-563.] DOI: 10.13705/j.issn.1671-6825.2020.12.127.

9.李宗辉, 刘敏. 外固定支架联合负压封闭引流治疗GustiloⅢ型胫腓骨开放性骨折患者的临床疗效[J]. 医疗装备, 2021, 34(20): 79-80. [Li ZH, Liu M. Clinical effect of external fixation combined with negative pressure closed drainage in the treatment of Gustilo type Ⅲ open tibial and fibular fractures [J]. Chinese Journal of Medical Device, 2021, 34(20): 79-80.] DOI: 10.3969/j.issn.1002-2376.2021.20.039.

10.童磊. 开放性骨折患者术后感染及对血清TLR-2、MCP-1、IL-6水平的影响[J]. 实验与检验医学, 2021, 39(6): 1550-1553. [Tong L. Postoperative infection and its effect on serum levels of TLR-2, MCP-1 and IL-6 in patients with open fracture[J]. Experimental and Laboratory Medicine, 2021, 39(6): 1550-1553.] DOI: 10.3969/j.issn.1674-1129.2021.06.058.

11.俞莹娣, 陈燕利, 朱巧爱, 等. 两种不同方法联合负压封闭引流技术对胫腓骨开放性骨折合并软组织缺损患儿踝关节功能的影响[J]. 中国医刊, 2022, 57(10): 1101-1104. [Yu YD, Chen YL, Zhu QA, et al. Effects of two different methods combined with vacuum sealing drainage on ankle function in children with tibiofibular open fracture and soft tissue defects[J]. Chinese Journal of Medicine, 2022, 57(10): 1101-1104.] DOI: 10.3969/j.issn.1008-1070.2022.10.016.

12.赵鑫, 石新, 陈贝, 等. 负压封闭引流技术对大鼠急性创面愈合过程中Ⅰ/Ⅲ型胶原比例变化的影响[J]. 中国组织工程研究, 2020, 24(32): 5122-5127. [Zhao X, Shi X, Chen B, et al. Vacuum sealing drainage enhances wound healing by up-regulating collagen type I/III ratio in rats[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(32): 5122-5127.] DOI: 10.3969/j.issn.2095-4344.2859.

13.马明亮, 周楠, 刘宏智, 等. 可调节组合式外固定器治疗胫腓骨干开放性骨折的效果观察[J]. 实用临床医药杂志, 2021, 25(4): 73-76. [Ma ML, Zhou N, Liu HZ, et al. Effect of adjustable combined external fixator in treating open tibiofibular shaft fractures[J]. Journal of Clinical Medicine in Practice, 2021, 25(4): 73-76.] DOI: 10.7619/jcmp.20200966.

14.张自然. 外固定器结合封闭负压引流治疗四肢骨关节严重开放性骨折的效果观察[J]. 中国医疗器械信息, 2019, 25(6): 116-117. [Zhang ZR. Observation on the effect of external fixator combined with closed negative pressure drainage in the treat-ment of severe open fracture of extremities and joints[J]. China Medical Device Information, 2019, 25(6): 116-117.] DOI: 10.15971/j.cnki.cmdi.2019.06.059.

15.朱禧, 吴昊, 施建党, 等. 清创联合抗生素溶液局部持续灌注引流治疗胸腰椎后路内固定术后早期切口深部感染的疗效观察[J]. 中国脊柱脊髓杂志, 2021, 31(4): 365-369. [Zhu X, Wu H, Shi JD, et al. The effect of debridement and local continuous irrigation and drainage with antibiotic solution for treating postoperative deep infection of surgical incision after thoracolumbar posterior internal fixation[J]. Chinese Journal of Spine and Spinal Cord, 2021, 31(4): 365-369.] DOI: 10.3969/j.issn.1004-406X.2021.04.13.