胫腓骨开放骨折外固定改内固定后发生并发症的影响因素  

Complication factors investigation of tibia and fibula open fractures internal fixation after external fixation

作　　者：尚修帅 王祥[1] 顾剑华[1] 祝加学[1] 刘勇章[1] 金晨[1] 胡小鹏[1] 陶海荣[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海201999

出　　处：《临床骨科杂志》2016年第6期732-734,共3页Journal of Clinical Orthopaedics

基　　金：上海市卫计委科研基金(编号:201540274)

摘　　要：目的：探讨胫腓骨开放骨折去除外固定器改内固定后发生并发症的影响因素。方法回顾分析54例胫腓骨开放骨折一期临时外固定二期改内固定手术患者的临床资料，包括二期术前白细胞计数（ WBC）、中性粒细胞（ N）、超敏C-反应蛋白（ hs-CRP）、血沉（ ESR）、降钙素原（ PCT）、外固定器放置时间等情况，评价各项指标对内固定术后皮肤坏死缺损、感染率、骨折愈合时间及踝关节功能的影响。结果54例均获得随访，时间10-12个月。 N、hs-CRP、PCT是术后感染、皮肤坏死缺损、骨折延迟愈合、踝关节功能障碍并发症的相关危险因素，多元Logistic回归分析3项指标的P值分别为0．029、0．046、0．011。结论胫腓骨开放骨折外固定改内固定应待N、hs-CRP、PCT 3项指标降至正常区间后施行手术，可减少术后感染、皮肤坏死缺损、骨折延迟愈合、踝关节功能障碍并发症发生。Objective To investigate influence factors of complications occurrence after shifting external fixator to plate fixation on open tibia and fibula fracture. Methods Clinical data of 54 cases experienced internal fixation after external fixation were retrospectively analyzed, collecting results of blood tests included WBC, N, hs-CRP, ESR, PCT, external fixation period. After internal fixation, postoperative skin necrosis defect, infection, fracture healing time were evaluated. Results All 54 cases got 10-12 months follow-up. N, hs-CRP and PCT related risk factors were statistically significant. Multiple-Logistic regression analysis P values were 0. 029, 0. 046, 0. 011 respectively. Conclusions When open tibia and fibula fracture fixation change from external fixation to inner, the N, hs-CRP, PCT inflammatory markers should return to normal range before operation, so that reducing the incidence of postopera-tive complications.

关 键 词：胫腓骨开放骨折 中性粒细胞 超敏C-反应蛋白 降钙素原 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]