[Application of vacuum sealing drainage combined with antibiotic bone cement in Gustilo type Ⅲ open ankle fractures].

Abstract

Objective: To investigate clinical efficacy of vacuum sealing drainage (VSD) combined with antibiotic bone cement in treating Gustilo type Ⅲ open ankle fractures.

Methods: From December 2022 to December 2024, 120 patients with Gustilo type Ⅲ open fractures of ankle were treated, and were divided into control group and VSD group according to treatment methods. In control group, there were 58 patients, including 35 males and 23 females;aged from 25 to 58 years old with an average of (45.93±12.82) years old;14 patients with type Ⅲ A, 27 patients with type Ⅲ B, and 17 patients with type Ⅲ C according to Gustilo classification;treated with VSD. In VSD group, there were 62 patients, including 41 males and 21 females;aged from 23 to 58 years old with an average of (45.24±13.05) years old;16 patients with type Ⅲ A, 31 patients with type Ⅲ B, and 15 patients with type Ⅲ C according to Gustilo classification;treated with VSD combined with antibiotic bone cement. The wound healing time, fracture healing time, hospital stay, and postoperative complications between two groups were recorded and compared. The changes in white blood cell count (WBC), neutrophil percentage (NEU), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were compared between two groups before operation and 1 month after operation. The secretions from patients' wounds were collected for isolation, culture and identification of pathogenic bacteria before operation, 7 and 14 days after operation. The clinical efficacy was evaluated by using American Orthopaedic Foot and Ankle Society (AOFAS) ankle function score to assess recovery of ankle joint function at 6 months after operation.

Results: All patients were followed up for 8 to 12 months with average of (9.3±2.6) months. The wound healing time, fracture healing time and hospital stay in VSD group were (26.7±4.2) days, (6.9±1.3) months and (30.8±4.7) days respectively, which were better than those in control group (32.3±5.6) days, (8.7±1.8) months, (35.6±5.1) days, and the differences were statistically significant(P<0.05). At 1 month after operation, the levels of WBC, NEU, ESR and CRP in VSD group were(7.3±1.2) × 10⁹·L^-1, (60.6±5.7)%, (17.9±4.8) mm·h^-1 and (7.1±1.8) mg·L^-1 respectively, which were better than those in control group (9.6±1.5)×10⁹·L^-1, (67.8±6.3)%, (26.8±5.3) mm·h^-1, (10.6±3.2) mg·L^-1, and the differences were statistically significant between two groups(P<0.05). Among 97 patients with preoperative wound infections, a total of 132 pathogenic bacteria were isolated. The main species were escherichia coli (37, 28.0%), staphylococcus aureus (24, 18.2%), and pseudomonas aeruginosa (19, 14.4%). The pathogen clearance rate at 14 days after operation in VSD group (100%, 50/50) was higher than that in control group (63.8%, 30/47), and the difference was statistically significant (P<0.05). At 6 months after operation, AOFAS score of VSD group was (83.5±4.2) points, which was higher than that of control group (72.1±5.3) points, and the difference was statistically significant (P<0.05). There was no statistically significant difference in postoperative complications between two groups (P>0.05).

Conclusion: The combination of VSD and antibiotic bone cement could effectively accelerate wound and fracture healing, shorten hospital stay, better control infection and inhibit inflammatory response, promote ankle joint function recovery, and does not increase the risk of complications.