Application Of Vacuum Sealing Drainage(VSD) Combined With Ilizarov External Fixator In Treating Infected Open Tibia And Fibula Fractures

[Objective]To observe and evaluate the clinical efficacy of Vacuum Sealing Drainage(VSD)combined with Illizarov external fixator in the treatment of infected open tibia and fibula fractures and compare it with conventional dressing change,so as to explore the best clinical treatment for infected open tibia and fibula fractures.[Methods]This was a retrospective clinical research including 36 patients with infected open tibia and fibula fractures who were admitted to the Department of orthopedics in our hospital from 2017/07 to 2018/07.Twenty patients in the treatment group were treated with Illizarov external fixator and VSD.Sixteen patients in the control group were treated with Illizarov external fixator and routine dressing change.The indication of the patients were evaluated and the comorbidities were treated before operation.Wound debridement was performed firstly.Then Illizarov external fixator were installed and fixed followed with fractures reduction.Finally,wounds were treated with either VSD or conventional dressing.The wound healing parameters(healing time,dressing change times,skin grafting effect),fracture healing parameters(fracture healing time,osteomyelitis,delayed healing,nonunion and other complications)were assessed and recorded.The excellent and good rates were calculated according to Johner-Wruh criteria for evaluating the curative effect of tibial shaft fractures.The health survey(the MOS item short from health survey,SF-36)was used to evaluate the postoperative quality of life.[Results]In the observation group,the average follow-up time was(16.5±3.8)months.The average number of VSD dressings replacement was(4.1±1.9)times.The average healing time of wounds was(34.5±12.8)days.The average postoperative VAS score was(3.2±1.4),and 1 patient(5.0%)was positive for bacterial culture.In the control group,the average follow-up time was(15.9+3.4)months.The average dressing change were(19.8±5.3)times.The average healing time of the wounds was(59.7±16.4)days.The average VAS score was(5.8±1.7).Three patients(18.8%)were positive for bacterial culture.There was significant difference between the two groups(p<0.05).The average healing time of fracture in the observation group was significantly shorter than that in the control group(6.7±1.8 vs 9.5±2.3 months,P=0.008).There were 2 cases with delayed healing of fracture in the observation group,but no complications of nonunion and osteomyelitis were observed.According to the Johner-Wruh evaluation results of tibial shaft fracture,the overall excellent and good rate of the observation group was higher than that of the control group(95%vs 75%).The SF-36 scores in the observation group were significantly higher than those in the control group(p<0.05).[Conclusion]VSD combined with Ilizarov external fixator has definite clinical efficacy.Fracture fixation is safe and reliable with shortened wound healing time,fewer complications,reduced infection risk,reduced pain and significantly improved quality of life.It is an ideal treatment method for infected open fracture of tibia and fibula,which is worthy of clinical application.