胫骨骨折术后迟发性感染治疗的对照研究  

A comparative study on the treatment of delayed infection after internal fixation of tibia fracture

作　　者：王晓民 唐小莹 孙贵新[1] WANG Xiao-min;TANG Xiao-ying;SUN Gui-xin(Department of Orthopedic Trauma,East Hospital of Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院创伤外科,上海200120

出　　处：《创伤外科杂志》2020年第12期895-898,共4页Journal of Traumatic Surgery

摘　　要：目的对照研究胫骨骨折术后迟发性感染的治疗效果,为胫骨骨折内固定术后迟发性感染的治疗提供参考依据。方法回顾性分析2010年3月—2017年9月同济大学附属东方医院创伤外科实施胫骨骨折钢板内固定术后感染患者29例,男性19例,女性10例;年龄20~79岁,平均46.7岁。均为迟发性感染(内固定术后2~10周发生感染),确诊感染时间3~8周,其中延期取出植入物组(延期组)15例,早期清创、一期取出植入物组(早期组)14例。延期组行清创、VSD及抗感染治疗,视愈合情况去除内固定;早期组行清创、一期内固定取出术及抗感染治疗,骨折端稳定的给予VSD治疗,不稳定的给予外固定及VSD治疗。对两组患者平均住院天数、平均感染控制时间、平均骨折愈合时间、平均手术次数及慢性骨髓炎发生率等指标进行统计学分析。结果延期组与早期组患者平均住院天数[(41.5±9.4)d vs.(20.8±4.8)d]、平均感染控制时间[(85.3±13.7)d vs.(16.6±4.1)d]、平均骨折愈合时间[(24.8±4.4)周vs.(14.4±2.7)周]、平均手术次数[(3.3±1.2)次vs.(1.4±0.9)次]比较差异均有统计学意义(P<0.05)。慢性骨髓炎发生率(20.0%vs.7.1%)比较差异无统计学意义(P>0.05)。延期组治疗有效率66.7%,早期组92.8%,差异有统计学意义(P<0.05)。结论对胫骨骨折内固定术后迟发性感染患者早期行清创、一期内固定取出术,可以有效控制感染,获得满意疗效。Objective To conduct a comparative study on the treatment of delayed infection after internal fixation of tibial fracture,so as to provide a reference basis for the treatment of delayed infection after internal fixation of tibial fracture.Methods Retrospective analysis was conducted in 29 patients with infection after internal fixation of tibial fracture plate who were admitted into our hospital from Mar.2010 to Sep.2017.There were 19 males and 10 females,with an average age of 46.7 years(range,20-79 years).All patients had delayed infection(infection occurred 2-10 weeks after internal fixation),and the average time for confirming infection was 3-8 weeks.There were 15 patients in the delayed group(delayed removal of implants),and 14 patients in the early group(early debridement,and the first-stage removal of implants).Debridement,VSD and anti-infection treatment were performed in the delayed group,and internal fixation was removed according to the healing condition.In the early group,debridement,first-stage fixation and removal,and anti-infection treatment were performed;the stable fracture end was treated with VSD,and unstable with external fixation and VSD.Statistical analysis was performed on the average length of hospital stay,the average infection control time,the average fracture healing time,the average number of surgeries and the incidence of chronic osteomyelitis in the two groups.Results There were statistically significant differences between the two groups in the average length of hospital stay[(41.5±9.4)days vs.(20.8±4.8)days],the average infection control time[(85.3±13.7)days vs.(16.6±4.1)days],the average fracture healing time[(24.8±4.4)weeks vs.(14.4±2.7)weeks],and the average number of surgeries[(3.3±1.2)times vs.(1.4±0.9)times](P<0.05).The incidenee of chronic osteomyelitis rate of the delayed group was 20.0%,which was 7.1%in the early group,and the difference was not statistically significant between the two groups(P>0.05).The treatment effect of the early group was better than that of

关 键 词：胫骨骨折 迟发性感染 内固定 植入物 

分 类 号：R683.42[医药卫生—骨科学]