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1、山西医科大学硕士学位论文suture.Ifthewoundislarger,granulationtissuegrowwellcanuseskingraftingtoclosethewound,Ifthewoundisstillvisiblemorenecrotictissueanddeep,lineofdebridementandagainnexttheVSDtreatmentcycle,payattentiontograduallyreducetheVSDdressingstoadapttothesizeofthewound,Repeattreatmentuntilthewound
2、cansutureorskingraftorskinflaptransplantationmethodstoclosed.Results：32casesoftypeGustiloⅢopentibiofibulafractureswithvacuumsealingdrainagetreatpostoperativeinfection,woundinfectiondegreeareimproved.Thedurationofcleantraumasurfacewas7-48days，averagingoutat(24.1±10.5)days.Line24patientsofskingraf
3、torskinflaptransplantationmethods.Thedurationofskingrafttraumasurfacewas11~61days,averagingoutat(35.9±14.8)days.14casesofskingraftcurativeeffectforoptimal,7casesofskingraftcurativeeffectforfavorable,2casesofskingraftcurativeeffectforfeasible,1casesofskingraftcurativeeffectforinferior.Thesuccessr
4、ateofskingraftingwas95.8%,Thedurationofuniontraumasurfacewas18-137days,averagingoutat(57.7±26.3)days.Threepatientsosteomyelitis,incidencerate9.38％,1caseoffracturenonunion,incidencerate3.13％,1caseofrecurrenceofwoundinfectionafterhospitaldischarge,incidencerate3.13％.Conclusion:Throughclinicalobser
5、vation,TheVSDintypeGustiloⅢopentibiofibulafracturecomplicatedwithinfectionofthetreatmentofpatientswithcaneffectivelycontroltheinfection,promotewoundsofttissuegrowth,improvethetherapeuticefficacyofskingraft,shortenthewholecourseofthedisease,reducethecomplicationsandinfectionrecurred.Itisaneffecti
6、vemethodfortreatmentofopenfracturesofpostoperativeinfection.Keywords:vacuumsealingdrainage;Opentibiofibulafractures;infectionIV山西医科大学硕士学位论文前言开放性胫腓骨骨折是在临床中最常见的开放性骨折类型，由于多数是高能量损伤导致伤情较为严重，临床处理较为困难。尤其是骨折合并有软组织缺损或血管损伤的Gustilo-AndersonIII型开放性骨折，因为各种原因导致的治疗不当极易造成软组织感染；骨、肌腱及内固定物外露；骨髓炎、骨折不愈合等并发症。而特别是在行骨折
7、固定术后的创面发生感染，由于固定物的存在，使感染的治疗更为棘手，并且往往会影响手术的效果，甚至导致前期治疗工作功亏一篑，加重病情。目前开放性骨折术后感染的常规治疗方法是将感染创面反复清创、灌洗引流、频繁换药，待创面新鲜清洁后再行缝合、植皮或皮瓣移植等方式闭合创面，不过此方法治疗时间长、感染控制不佳、患者承受痛苦多。因此在临床上，行负压封闭引流技术(vacuumsealingdrainage，VSD)代替常规治疗方法日益多见。笔者于2011年6月
