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目的：观察游离植皮联合负压封闭引流（vacuum sealing drainage，后文简称VSD）对骨科创面的疗效，并与植皮后传统加压包扎相比较，为临床实践提供更好的治疗方法。方法：对广州中医药大学第一附属医院创伤骨科2008 年3月至2010年2月收治的65例感染创面病例采取手术清创后予VSD 引流，合理应用抗生素，创面感染得到控制后，创面干净，肉芽生成良好，外露的肌腱、骨膜表面有新鲜的肉芽组织覆盖，达到植皮的要求后，随机分成两组，其中30 例（实验组）采用游离植皮联合VSD 法闭合创面，35例（对照组）采用游离植皮加压包扎植皮区，对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）进行统计学分析，采用t 检验和卡方检验，对此两种方法进行评价。结果：植皮联合 VSD 组与植皮加压包扎组，在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）的对比，有显著性差异（P<0.05）。结论：创面达到游离植皮条件后，游离植皮联合VSD负压引流可以促使皮片黏附，保持创面洁净，避免皮下渗液积聚，有利于皮片的存活，与植皮加压包扎组相比，减少了平均换药次数，缩短创面平均愈合时间及平均住院时间（植皮后），减少抗生素平均应用次数，提高了植皮成活率，说明游离植皮联合VSD 组优于游离植皮加压包扎组，游离植皮联合VSD法治疗骨科创面有显著疗效。该手术方法操作简单，术后护理方便，是一种较理想的植皮后的固定方法，有利于创面的愈合，值得临床推广应用。

英文摘要:

Objects: To evaluate the clinical outcome of vacuum sealing drainage(VSD)after dermatoplasty and Compression bandagechoice for the treatment of dermatoplasty with satisfactory effectiveness in patients with the orthopaedic wound. It is worth popularizing in clinic praticts. after dermatoplasty in the treatment of the orthopaedic wound, analyze the factors which influence the clinical outcome, and then provide a better treatment for clinical practice. Methods: 65 patients, who were in Traumatic orthopedic of the first hospital of Guangzhou University of TCM from March 2008 to February 2010,they were chosen. After debridement and covering VSD serval times, the wounds'infection were controlled,when the wounds became clean,and the tendons and bones were covered by fresh granulation tissue, We randomly devided into two groups,30 patients（the experimental group）received dermatoplasty with superficial or moderate thickness free skin graft and VSD,35 patients (the control group) received dermatoplasty with superficial or moderate thickness free skin and compression bandage. The VSD was removed one week later, and the compression bandage was removed about seven days or ten days later. And then we analyze and compare the therapeutic effect by T test and X2 test, analyze the average number of dressing changes, the average time of wound healing, the average survival rate of skin graft, the average time in hospital after skin graft, the average frequecy of antibiotic after skin graft in the two groups. Result: Compared the experimental group with the control group, we found out that the experimental group's average number of dressing changes was fewer, the average time of wound healing was shorter, the average survival rate of skin graft was higher, the average time in hospital after skin graft was shorter, the average frequecy of antibiotic after skin graft was fewer. The differences of the results were significant(P<0.05). Conclusion: After the wound is reached dermatoplasty conditions, free dermatoplasty combined with vacuum sealing drainage group can make the skin to keep stick, and avoid subcutaneous drainage accumulation, it's good for the skin to survive. Compare with the control group, the experimental group reduced the frequency of dressing changes, shortened the average time of wound healing and the average time in hospital,reduced the average frequecy of antibiotic after skin graft, improve the average survival rate of skin graft. So the experimental group has better effect than the control group in wound healing. The method of this operation is easy to be manipulated and convenient to be nursed after operation, and is a good

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