清创术后持续灌洗联合VSD治疗胫腓骨开放性骨折术后感染的效果观察  

Observation on the Effect of Continuous Lavage after Debridement Combined with VSD in the Treatment of Postoperative Infection of Open Tibia and Fibula Fractures

作　　者：袁情 杨重飞 贾瑛 李潇 YUAN Qing;YANG Chong-fei;JIA Ying;LI Xiao(The First Department of Orthopaedics of Xijing Hospital,the First Affiliated Hospital of PLA Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院西京医院骨一科,西安710032

出　　处：《临床误诊误治》2020年第12期70-74,共5页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省社发项目(2019SF-126)。

摘　　要：目的观察清创术后持续灌洗联合负压封闭引流(vacuum sealing drainage,VSD)治疗胫腓骨开放性骨折术后感染的效果。方法将2013年5月—2019年5月我院收治的58例胫腓骨开放性骨折术后感染患者据术后感染处理方法的不同均分为持续灌洗联合VSD组(VSD组)和常规持续灌洗组(常规组)。比较两组疗效,治疗相关指标(拔管时间、感染控制时间、伤口愈合时间),术前及术后1周血清炎性及应激反应指标[C反应蛋白(CRP)、去甲肾上腺素(NE)、皮质醇(Cor)]水平,以及治疗期间总并发症发生情况。结果VSD组总有效率为96.55%高于常规组的79.31%(χ^2=4.062,P=0.044)。VSD组拔管时间、感染控制时间、伤口愈合时间均短于常规组(P<0.01)。术后1周,两组血清CRP、NE、Cor水平均较术前降低,且术后1周VSD组上述指标亦低于常规组同时间,差异均有统计学意义(P<0.01)。两组治疗期间总并发症发生率比较差异无统计学意义(χ^2=0.744,P=0.389)。结论清创术后持续灌洗联合VSD治疗胫腓骨开放性骨折术后感染的效果确切,可显著缩短治疗时间,促进伤口愈合,减轻患者应激反应,且安全性良好。Objective To observe the effect of continuous lavage after debridement combined with vacuum sealing drainage(VSD)in the treatment of postoperative infection of patients with open tibia and fibula fractures.Methods Fifty-eight patients with open tibia and fibula fractures who had postoperative infection from May 2013 to May 2019 were divided into continuous lavage combined with VSD group(VSD group,n=29)and conventional continuous lavage group(conventional group,n=29)according to the different treatment methods for postoperative infection.The efficacy and treatment-related indicators(extubation time,infection control time,wound healing time),serum inflammatory and stress response indicators[C reactive protein(CRP),norepinephrine(NE),cortisol(Cor)]levels before surgery and at 1 week after surgery,and complications during treatment were compared between the two groups.Results The total effective rate in the VSD group was 96.55%,which was higher than 79.31%in the conventional group(χ^2=4.062,P=0.044).The extubation time,infection control time,and wound healing time in VSD group were all lower than those in conventional group(P<0.01).At 1 week after operation,the levels of serum CRP,NE and Cor in the two groups were lower than those before operation,and the above indicators in the VSD group were also lower than those in the conventional group at 1 week after operation(P<0.01).There was no significant difference in the total incidence rate of complications between the two groups(χ^2=0.744,P=0.389).Conclusion Continuous lavage combined with VSD has exact efficacy in the treatment of postoperative infection of patients with open tibia and fibula fractures,and it can significantly shorten the treatment time,promote wound healing,and reduce the stress response,with good safety.

关 键 词：骨折 开放性 胫腓骨 外科伤口感染 持续灌洗 负压封闭引流 C反应蛋白 去甲肾上腺素 

分 类 号：R683[医药卫生—骨科学]