多网管解剖型置管灌洗法治疗骨折术后继发慢性骨髓炎  

Multi-tube drainage network anatomical catheter lavage system for chronic osteomyelitis after frac- ture surgery

作　　者：崔健[1] 刑文钊[1] 孙梁[1] 张纯朴[1] 冯文岭[1] 孔志刚[1] 

机构地区：[1]河北医科大学第三医院骨伤科石家庄,050051

出　　处：《中华骨科杂志》2011年第8期877-883,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨多网管解剖型置管灌洗法在骨折术后继发慢性骨髓炎治疗中的应用价值。方法回顾性分析2006年6月至2008年12月收治的骨折术后继发慢性骨髓炎患者40例（41处）的病例资料，男35例，女5例；年龄16～68岁，平均42．7岁。对40例（41处）采用彻底清创、闭合死腔、多网管解剖型置管灌洗引流、全身及局部应用敏感抗生素等系列疗法治疗3～4周。术后每3个月复查，包括切口愈合情况、X线片表现、红细胞沉降率和C-反应蛋白。按灌洗治疗结束时炎症是否稳定及术后6个月时炎症是否复发制定疗效评价标准，参考指标包括伤口愈合情况、全身症状、红细胞沉降率及C-反应蛋白等。结果 按上述疗效判定标准，优37例，切口一期愈合，术后6个月时无复发；良2例，切口愈合稍差，经换药治疗后愈合，术后6个月时无复发；差1例，窦道复发，切口未愈。36例在术后半年行植骨内固定术，术后骨折愈合，4例未经植骨直接愈合。随访30～50个月，平均43．2个月，均无复发。结论多网管解剖型置管灌洗法对于骨折术后继发慢性骨髓炎的治愈率高，可操作性强，术后好管理，是一种有效的治疗方法。Objective To explore the clinical application of the multi-network anatomical lavage on the treatment of chronic osteomyelitis after fracture surgery. Methods A retrospective analysis of 40 pa- tients （41 sites） with chronic osteomyelitis after fracture surgery was performed from June 2006 to December 2008. There were 35 males and 5 females with an average of 42.7 years （range, 16-68）. All 40 cases were treated with debridement, closing the cavity, and placing the multi-tube drainage network anatomical catheter lavage system. At the same time, sensitive antibiotics were used for 3 to 4 weeks. Rechecks were scheduled every 3 months after operation, including wound healing, X-ray presentation, ESR and C-reactive protein. Cure criteria depends on the conditions of the inflammation when the lavage treatment was over, and whether it relapsed six months after operation, including wound healing, systemic symptoms, ESR and C-reactive protein. Results Judged by the clinical outcomes when the lavage treatment was over and six months after operation, the effects were categorized into 3 levels, including excellent in 37 cases with primary wound healing, and without relapse six months later; good in 2 with poor wound healing, the wound healed after a period of treatment without recurrence; poor in one with recurrent sinus infection and a prolonged unhealed wound, after another operation he was healed. 36 cases were treated with bone graft and internal fixation op- eration, and the fractures were healed after surgery, the fractures were healed directly in 4 cases without bone graft. The patients were followed up for an average of 43.2 months （range, 30-50） after operation, and none relapsed. Conclusion The multi-tube drainage network anatomical method is feasible and effective on the treatment of chronic osteomyelitis after fracture surgery with a high cure rate.

关 键 词：骨折 骨髓炎 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]