两种清创方法治疗GustiloⅢ型开放性骨折的疗效和卫生经济学观察  

Clinical efficacy and cost-effectiveness of two debridement methods for Gustilo type Ⅲ open fracture

作　　者：朱传正 陈祝锋 王育才 Zhu Chuanzheng;Chen Zhufeng;Wang Yucai(Department of Orthopaedics,Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学第二附属医院骨科,西安710038

出　　处：《创伤外科杂志》2021年第3期182-187,共6页Journal of Traumatic Surgery

摘　　要：目的比较水动力清创系统清创与常规清创在开放性四肢骨折清创中的效果及经济实用性。方法采用回顾性队列研究,选择2017年12月—2019年12月空军军医大学第二附属医院骨科收治接受清创植皮或皮瓣治疗的开放性骨折(GustiloⅢ型)患者46例,根据清创方式不同分为水刀清创组(21例)和常规清创组(25例)。水刀清创组男性16例,女性5例;年龄38~78岁,平均59.4岁;常规清创组男性22例,女性3例;年龄29~79岁,平均52.8岁。观察比较两组患者术中出血量,首次清创所用时间,术前及术后白细胞、中性粒细胞、超敏C反应蛋白、白蛋白水平的变化,创面准备时间,创面准备所需清创次数,住院时间、费用及感染率。结果清创后1、3、7d,常规清创组患者白细胞、中性粒细胞和超敏C反应蛋白水平显著高于水刀清创组。水刀清创组首次清创时间(27.2±9.5)min、创面准备时间(13.2±4.5)d、住院时间(22.5±4.1)d均显著少于传统清创组(40.4±6.8)min,(15.8±4.2)d,(24.8±3.8)d,P<0.05。两组患者术中出血量、白蛋白下降程度、住院费用及感染发生率比较,差异均无统计学意义(P>0.05)。结论水刀清创可明显缩短开放性骨折患者的手术时间,减轻炎症反应,减少清创次数,缩短创面准备时间和住院时间,可能减少术中出血量、白蛋白损失和增加住院费用。两种清创方式感染率方面无显著差异,若能降低水刀使用成本,水动力清创系统有望取代传统清创方法,成为开放骨折患者的常规清创手段。Objective To compare the clinical efficacy and cost-effectiveness of debridement with hydrosurgery debridement and conventional debridement in open limb fractures.Methods A retrospective cohort study was performed.Patients with open fractures(Gustilo typeⅢ)admitted to the Department of Orthopaedics,Second Affiliated Hospital of Air Force Military Medical University from Dec.2017 to Dec.2019 were selected for the study.According to different debridement methods,they were divided into hydrosurgery debridement group and conventional debridement group.There were 21 cases in hydrosurgery debridement group,including 16 males and 5 females,with an average of 59.4 years(ranging from 38 to 78 years).There were 25 patients in the debridement group,including 22 males and 3 females,with an average of 52.8 years(ranging from 29 to 79 years).Intraoperative blood loss,time taken for the first debridement,the preoperative and postoperative white blood cells,changes in neutrophils,hypersensitive C-reactive protein,albumin levels,wound preparation time,number of debridements,hospital stay,costs and the infection rate were observed and compared between the two groups.Results The levels of leukocytes,neutrophils,and hypersensitive C-reactive protein were significantly higher in the patients of the conventional debridement group than the hydrosurgery debridement group.On the 1st,3rd,and 7th days after treatment,the time of the first debridement in the hydrosurgery debridement group was(27.2±9.5)minutes,the wound preparation time was(13.2±4.5)days and the hospital stay time was(22.5±4.1)days,all significantly less than those in the conventional debridement group[(40.4±6.8)minutes,(15.8±4.2)days,(24.8±3.8)days,P<0.05].The blood loss and albumin level of the patients in the hydrosurgery debridement group were slightly lower than those in the conventional debridement group,and the hospitalization cost was slightly higher than that in the conventional debridement group,but there was no statistical difference(P>0.05).There was no s

关 键 词：四肢骨折 水动力清创系统 植皮 卫生经济学 

分 类 号：R683.4[医药卫生—骨科学]