外固定器结合封闭负压引流术降低开放性胫腓骨骨折术后感染效果及临床价值研究  

Effect and clinical value of external fixator combined with closed negative pressure drainage in reducing postoperative infections in patients with open tibiofibular fractures

作　　者：陈武林 阮成群 孙群周 梁国辉 李跃京 赵敏 CHEN Wu-lin;RUAN Cheng-qun;SUN Qun-zhou;LIANG Guo-hui;LI Yue-jing;ZHAO Min(Luoyang Bone-setting Hospital of Henan province(Orthopedic Hospital of Henan Province), Luoyang , Henan 471002, China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋关节三科,河南洛阳471002

出　　处：《中华医院感染学杂志》2019年第7期1076-1079,1087,共5页Chinese Journal of Nosocomiology

基　　金：河南省中医药管理局中医基金资助项目(2017ZY2088)

摘　　要：目的研究外固定器结合封闭负压引流术降低开放性胫腓骨骨折术后感染效果及临床价值。方法选取2016年12月-2017年10月胫腓骨骨折患者108例,采用随机数字表法,按照1∶1比例,将纳入者随机分为试验组和对照组,各54例。试验组采用外固定器结合封闭负压引流技术、对照组采用外固定器联合传统持续灌注冲洗干预,观察和比较两组患者骨折愈合效果、术后感染率、创面愈合时间、抗菌药物使用时间、骨折愈合时间、住院时间和骨髓炎发生率、骨折不愈合率及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。结果试验组骨折愈合临床治愈率70.37%、总有效率98.15%,高于对照组临床治愈率53.70%、总有效率81.48%(P <0.05);试验组术后感染率9.26%、骨髓炎发生率1.85%、骨折不愈合率1.85%,均低于对照组的25.93%、20.37%、18.52%(P<0.05);试验组患者术后创面清洁时间、创面愈合时间、感染控制时间、抗菌药物使用时间、骨折愈合时间、住院时间,均少于对照组患者(P<0.05);术后第3、5、7、14天的APACHEⅡ评分均低于对照组患者(P<0.05)。结论外固定器结合封闭负压引流技术能显著降低开放性胫腓骨骨折术后感染率,更好地促进创面愈合与骨折愈合,优于传统治疗方法,值得推广使用。OBJECTIVE To study the effect and clinical value of external fixator combined with closed negative pressure drainage in reducing postoperative infection of patients with open tibiofibular fracture. METHODS 108 patients with tibiofibular fractures from Dec. 2016 to Oct. 2017 were enrolled in this study and randomly divided into the experimental group and the control group, 54 cases each. The experimental group was treated with external fixator combined with closed negative pressure drainage technique, and the control group was treated using external fixator combined with traditional continuous perfusion washing intervention. The fracture healing effect, postoperative infection rate, wound healing time, antibacterial drug use time, fracture healing time, hospitalization time and incidence of osteomyelitis, fracture nonunion rate and acute physiology and chronic health status scoring system II Rating (APACHE II) of the two groups were observed and compared. RESULTS The clinical cure rate of fracture healing in the experimental group was 70.37%, and the total effective rate was 98.15%, significantly higher than those of the control group, which were 53.70% and 81.48%, respectively (P<0.05). The postoperative infection rate was 9.26%, the incidence of osteomyelitis was 1.85 %, and the rate of nonunion of the fracture was 1.85 % in the experimental group, significantly lower than the corresponding values (25.93%, 20.37 %, and 18.52 %) of the control group (P<0.05). The wound cleansing time, wound healing time, infection control time, the time of antibacterial use, fracture healing time and hospitalization time in the experimental group were all significantly lower than those of the control group (P<0.05). The APACHE II scores on the 3rd, 5th, 7th and 14th day after operation were also significantly lower than those of the control group (P <0.05). CONCLUSION External fixator combined with closed negative pressure drainage technology can significantly reduce the postoperative infection rate of open tibiofibular fracture,

关 键 词：胫腓骨骨折 外固定器 封闭负压引流术 感染 效果 

分 类 号：R619.3[医药卫生—外科学]