不同外科治疗方案在胫骨平台骨折不愈并发慢性感染患者中的疗效  

Therapeutic effects of different surgical treatment schemes on unhealed tibial plateau fracture complicated with chronic infections

作　　者：董泽民[1] 马信文 边绍清[1] 

机构地区：[1]攀枝花市第二人民医院骨外科,四川攀枝花617068

出　　处：《中华医院感染学杂志》2017年第6期1337-1340,共4页Chinese Journal of Nosocomiology

基　　金：四川省卫生医药科技计划基金资助项目(201537429)

摘　　要：目的探讨不同外科治疗方案在胫骨平台骨折不愈并发慢性感染患者中的疗效,为提升胫骨平台骨折不愈并发慢性感染患者临床疗效提供科学依据。方法选取医院骨科收治的胫骨平台骨折不愈并发慢性感染患者154例,分为对照组和研究组,每组77例,对照组给予锁定钢板内固定,研究组给予髓内钉内固定,比较两组患者的一般治疗情况,术后并发症,膝关节功能及骨痂生长情况,统计术前病原菌的分布和术后感染病原菌的分布情况。结果研究组患者手术时间、骨折愈合时间、创面愈合时间以及住院天数均低于对照组,差异有统计学意义(P<0.05);研究组患者术后感染,关节伸直受限,断针,骨不连的比例低于对照组,差异具有统计学意义;对照组分离培养出病原菌86株,革兰阳性菌占58.4%,革兰阴性菌占37.1%,真菌4.5%,研究组分离出病原菌89株,革兰阳性菌占61.6%,革兰阴性菌占34.9%,真菌3.5%;治疗后对照组分离培养出13株病原菌,革兰阴性菌占61.5%,革兰阳性菌占30.8%,真菌7.7%,研究组分离出病原菌3株,革兰阴性菌66.7%,真菌33.3%;治疗后,与治疗前相比,两组患者膝关节功能和骨痂生长评分均有明显提升,观察组患者膝关节功能和骨痂生长评分显著高于对照组,差异有统计学意义(P<0.05)。结论与锁定钢板内固定相比,髓内钉内固定可以有效地提升胫骨平台骨折不愈合并发慢性感染的患者的总体疗效,降低术后并发症。OBJECTIVE To explore the therapeutic effects of different surgical treatment schemes on unhealed tibial plateau fracture complicated with chronic infections so as to provide scientific basis for improvement of clinical effect on treatment of the unhealed tibial plateau fracture complicated with chronic infections.METHODS A total of154 unhealed tibial plateau fracture patients complicated with chronic infections who were treated in the orthopedics department were enrolled in the study and divided into the control group and the study group,with 77 cases in each.The control group was treated with locking plate internal fixation,while the study group was given intramedullary nail fixation.The general treatment status,postoperative complications,knee joint function,and growth of callus were observed and compared between the two groups of patients.RESULTS The operation duration,healing time of fracture,wound healing time,and length of hospital stay were significantly shorter in the study group than in the control group（P〈0.05）.The proportions of the patients with postoperative infection,limited joint extension,broken needle,and bone nonunion were significantly lower in the study group than in the control group.Totally 86 strains of pathogens were isolated in the control group,of which 58.4% were gram-positive bacteria,37.1% were gram-negative bacteria,and 4.5% were fungi.Totally 89 strains of pathogens were isolated in the study group,of which 61.6% were gram-positive bacteria,34.9% were gram-negative bacteria,and3.5% were fungi.After the treatment,totally 13 strains of pathogens were isolated in the control group,of which61.5% were gram-negative bacteria,30.8% were gram-positive bacteria,and 7.7% were fungi;totally 3strains of pathogens were isolated in the study group,of which 66.7% were gram-negative bacteria,and 33.3%were fungi.The knee joint function and callus growth scores of the two groups of patients were significantly increased after the treatment;the knee joint function and callus growth score of the o

关 键 词：锁定钢板内固定 髓内钉内固定 胫骨平台骨折不愈 慢性感染 

分 类 号：R683.42[医药卫生—骨科学]