外固定支架结合普朗特治疗合并多重耐药菌感染的开放性骨折的疗效分析  

External fixation combined with Prontosan management for open fractures complicated with multidrug-resistant bacterial infection

作　　者：王欣[1] 谢哲 李宗焕[1] 漆白文[1] 周敏[1] Wang Xin;Xie Zhe;Li Zonghuan;Qi Baiwen;Zhou Min(Department of Orthopaedic Trauma and Microsurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430071

出　　处：《中华创伤骨科杂志》2022年第6期503-509,共7页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省自然科学基金面上项目(2020CFB662)。

摘　　要：目的探讨外固定支架结合普朗特治疗合并多重耐药菌感染的开放性骨折的疗效。方法回顾性分析武汉大学中南医院创伤与显微骨科2015年1月至2020年1月期间收治的22例合并多重耐药菌感染的开放性骨折患者资料。根据患者是否结合普朗特治疗分为两组:普朗特组12例,男9例,女3例;年龄为(44.6±13.1)岁;采用外固定支架固定结合负压封闭引流技术(VSD)或常规换药治疗,同时应用普朗特冲洗创面或普朗特凝胶换药。对照组10例,男6例,女4例;年龄为(45.1±11.7)岁;采用外固定支架结合VSD或常规换药治疗。两组患者待创面感染控制后立即行皮瓣或植皮修复创面。记录并比较两组患者创面细菌培养转阴时间、清创次数、皮瓣或植皮存活情况及骨折愈合情况等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获10~24个月(平均14.5个月)随访。普朗特组患者的清创次数为2.0(2.0,3.0)次,显著低于对照组患者[4.0(3.0,4.0)次];创面细菌培养转阴时间为(8.3±2.2)d,显著短于对照组患者[(14.2±3.1)d];骨折愈合时间为(5.5±1.1)个月,显著短于对照组患者[(6.5±1.1)个月];术后6个月Samantha X线评分为6.0(5.0,6.0)分,显著高于对照组患者[5.2(4.5,5.5)分],以上项目两组之间比较差异均有统计学意义(P<0.05)。所有患者的皮瓣或植皮均存活,无骨不连及慢性骨髓炎发生。结论与未结合普朗特治疗比较,外固定支架结合普朗特治疗合并多重耐药菌感染的开放性骨折,可有效控制感染,促进肉芽组织生长,进而促进创面早日修复及骨折愈合。Objective To access the efficacy of external fixation combined with Prontosan management for open fractures complicated with multidrug-resistant bacterial infection.Methods A retrospective analysis was conducted of the data of 22 patients with open fracture complicated by multidrug-resistant bacterial infection who had been admitted to Department of Orthopedic Trauma and Microsurgery,Zhongnan Hospital of Wuhan University from January 2015 to January 2020.According to whether the Prontosan management was used or not,the patients were divided into 2 groups.The Protosan group[9 males and 3 females with an age of(44.6±13.1)years]were subjected to external fixation,vacuum sealing drainage(VSD)or conventional dressing changes,and at the same time Protosan management to flush the wound or Prontosan gel to change dressings.The control group[6 males and 4 females with an age of(45.1±11.7)years]were subjected to external fixation plus VSD or conventional dressing changes.Skin flaps or skin grafts were used to repair the wound immediately after the wound infection was controlled in both groups.The time for negative culture of the bacteria on the wound surface,number of debridement,survival of the skinflaps or grafts,and fracture union were recorded and compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups which were comparable(P>0.05).All patients were followed up for 10 to 24 months(mean,14.5 months).In the Prontosan group,the number of debridement was 2.0(2.0,3.0)times,significantly fewer than that in the control group[4.0(3.0,4.0)times];the time for negative bacterial culture(8.3±2.2)d,significantly shorter than that in the control group[(14.2±3.1)d];the fracture union time(5.5±1.1)months,significantly shorter than that in the control group[(6.5±1.1)months];the Samantha X-ray score at 6 months after operation 6.0(5.0,6.0)points,significantly higher than that in the control group[5.2(4.5,5.5)points](all P<0.05).Skin flaps or grafts survived in

关 键 词：骨折 开放性 外固定器 细菌感染 普朗特 伤口愈合 骨折愈合 

分 类 号：R687.3[医药卫生—骨科学] R446.5[医药卫生—外科学]