负压微管丝敷料辅助治疗胫骨骨折内固定术后早期感染合并软组织缺损  

Effectiveness of Drawtex hydroconductive dressing in treatment of early implantation-associated infection and soft tissue defect after internal fixation of tibial fracture

作　　者：李洪飞[1] 潘朝晖[1] 薛山[1] 赵玉祥[1] 

机构地区：[1]解放军第89医院医院骨病科,山东潍坊261021

出　　处：《中国修复重建外科杂志》2018年第1期45-50,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨负压微管丝敷料用于辅助治疗骨折内固定术后早期感染合并软组织缺损的可行性。方法取新西兰大白兔36只,于右后肢制备胫骨骨折内固定术后感染模型,并随机分为A、B、C 3组(n=12)。感染创面分别用负压微管丝敷料(A组)、壳聚糖溶液纱布(B组)、生理盐水纱布(C组)覆盖。每2天更换1次敷料。模型制备术后第1、14、21天行X线片检查;第21天大体观察创面情况后,取胫骨标本行微生物学检查及组织学观察。结果术后第21天,各组创面按照James分级标准分级,比较差异无统计学意义(χ~2=3.713,P=0.156)。X线片检查示,第1天3组动物均无骨质破坏,组间X线片评分比较差异无统计学意义(P>0.05);第14天仅B组出现轻微骨质溶解改变,A、C组X线片评分低于B组(P<0.05),A、C组间比较差异无统计学意义(P>0.05);第21天B、C组出现骨髓炎征象,明显骨质溶解改变,A组X线片评分低于B、C组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。术后第21天,细菌培养检查示,A组骨组织内细菌含量明显少于B、C组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。组织学观察示,A组仅见少量炎性细胞浸润,B、C组可见骨质破坏,并见大量急性炎性细胞;A组Smeltzer组织学评分显著低于B、C组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。结论负压微管丝敷料可用于胫骨骨折内固定术后早期感染合并软组织缺损的辅助治疗,效果优于壳聚糖纱布和生理盐水纱布。Objective To investigate the feasibility of Drawtex hydroconductive dressing in treatment of early implantation-associated infection and soft tissue defect after internal fixation of tibial fracture. Methods Thirty-six New Zealand rabbits were used to prepare the model of early implantation-associated infection after internal fixation of tibial fracture, and randomly divided into 3 groups（n=12）. The infected wounds were covered with Drawtex hydroconductive dressing（group A）, chitosan solution gauze（group B）, and normal saline gauze（group C）, respectively. The dressing was changed every 2 days. X-ray films were performed at 1, 14, and 21 days. The gross observation, microbiological evaluation,and histological observation were done at 21 days. Results There was no significant difference in the wound grading according to the James grading criteria between groups at 21 days（χ~2=3.713, P=0.156）. X-ray films showed no bone destruction in all groups at 1 day; and there was no significant difference in radiographic scores between groups（P0.05）.At 14 days, the mild osteolysis was observed in group B; the radiographic score was significantly lower in groups A and C than in group B（P0.05）, but there was no significant difference between groups A and C（P0.05）. At 21 days, the osteolysis and osteomyelitis were observed in groups B and C; the radiographic score was significantly lower in group A than in groups B and C（P0.05）, but there was no significant difference between groups B and C（P0.05）.Also, the microorganism in bone tissue of group A was less than that of groups B and C（P0.05）; and the difference between group B and group C was not significant（P0.05）. Histological observation showed the mild inflammatory cell infiltration in group A and many inflammatory cells in groups B and C. The Smeltzer histological score was significant lower in group A than in groups B and C（P0.05）; and there was no significant difference between groups B and C（P0.05）. Conclusion Drawtex

关 键 词：负压微管丝敷料 胫骨骨折 内固定 感染 并发症 兔 

分 类 号：R687.3[医药卫生—骨科学]