水刀病灶清除结合负压封闭引流技术治疗骨折内固定术后早期感染  

Treatment of early infection after fracture internal fixation by water jet debridement combined withnegative pressure wound therapy

作　　者：高伟[1] 高堪达[1] 李夏[1] 王秋根[1] 

机构地区：[1]上海交通大学附属第一人民医院创伤骨科、上海市创伤急救中心,201620

出　　处：《中华创伤骨科杂志》2017年第5期399-403,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨水刀病灶清除结合负压封闭引流技术治疗骨折内固定术后早期感染的效果。方法回顾性分析2013年10月至2015年3月收治的7例骨折内固定术后早期感染患者资料。男6例，女1例；平均年龄为43．6岁（36—58岁），初始骨折均为闭合性。感染出现后3～5d内行病灶清除手术。根据术前美蓝标记染色范围调整切口长短与深浅，使用水刀由浅至深进行彻底病灶清除，同时保留内固定物，稀疏全层缝合伤口，行负压封闭引流治疗。术后所有患者全身使用敏感抗生素至伤口愈合，创面封闭引流一般应用5d。结果所有患者伤口均在10—25d（平均18d）愈合。7例患者术后获平均12个月（8～24个月）随访。随访期间未使用任何抗生素，未再出现新窦道、破溃等局部症状和发热等全身症状，骨折处骨痂形成，无骨折不愈合发生，骨痂出现时间平均为4．3个月（2．5-8．0个月），骨折愈合时间平均为10．1个月（5．5—16．0个月）。所有患者均对最终治疗后的结果认可。结论水刀具有病灶清除简单、快速、彻底等优点，负压封闭引流可起到伤口闭合前的过渡治疗、简化手术步骤和加速切口愈合的作用，二者结合使用是一种治疗骨折内固定术后早期感染的有效方法。Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy （NPWT） for the treatment of early infection after fracture internal fixation. Methods The study cohort included 6 men and one woman with an average age of 43.6 years （range, from 36 to 58 years） who had presented with early infection after fracture internal fixation from October 2013 to March 2015. All the patients sustained closed fractures initially. The wound debridement was done within 3 to 5 days after the infection was confirmed. The length and depth of an incision was determined by the methylene staining range. Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained. The wound was closed by full thickness sutures in a sparse fashion for drainage. Sensitive antibiotics were systematically administered for all the patients. The NPWT device was kept for 5 days. Results All the wounds healed uneventfully after an average of 18 days （range, from 10 to 25 days）. The mean follow-up time was 12 months （range, from 8 to 24 months）. No antibiotics were used during follow-up. There were no local or systematical symptoms like new sinus, broken wound or fever. Bony callus formed at the fracture sites after an average of 4.3 months （range, from 2.5 to 8.0 months） and no fracture nonunion happened. All the fractures healed after an average of 10. 1 months （range, from 5.5 to 16.0 months）. All the patients were satisfied with their treatment outcomes. Conclusion Since water jet provides simple, rapid and radical debridemcnt while NPWT simplifies operative procedures and promotes wound healing, combination of the two can be an effective treatment for early infection after fracture internal fixation.

关 键 词：骨折固定术 感染 引流术 水刀 

分 类 号：R687.3[医药卫生—骨科学]