复杂胫骨平台骨折双侧钢板内固定术后慢性感染的诊疗策略探讨  

Discussion on the diagnosis and treatment strategy of chronic infection after bilateral plate internal fixation for complex tibial plateau fractures

作　　者：刘鹏 赵猛[1] 严永祥[1] 徐圣康[1] 张劲松[1] 罗斌[1] 赵星 Liu Peng;Zhao Meng;Yan Yongxiang;Xu Shengkang;Zhang Jingsong;Luo Bin;Zhao Xing(Department of Trauma Orthopedics,Shiyan Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan Hubei,442000,China)

机构地区：[1]湖北医药学院附属十堰市太和医院创伤骨科,湖北十堰442000

出　　处：《生物骨科材料与临床研究》2023年第3期45-49,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨一期取出感染侧内固定物、二期取出对侧内固定的方法,在治疗复杂胫骨平台骨折双钢板内固定术后慢性感染的临床疗效。方法回顾性分析湖北医药学院附属十堰市太和医院自2012年1月至2020年1月收治的复杂胫骨平台骨折于外院行双侧钢板内固定术后发生慢性感染的患者,共15例。其中,男8例,女7例;年龄为23~74岁,平均(59.3±14.3)岁;Schatzker分型Ⅴ型13例,Ⅵ型2例;所有患者来院时骨折线模糊或骨痂形成。根据患者创面分泌物微生物培养结果使用敏感抗生素抗感染治疗,一期手术仅取出感染侧内固定钢板,联合VSD负压引流治疗控制感染,待骨折愈合后二期手术取出对侧内固定钢板。结果所有患者在行取出感染侧内固定钢板+创面封闭式负压引流术(VSD)后,感染控制满意,术后无感染复发,骨折愈合后二期手术取出对侧内固定钢板,术前术后对侧均无感染,且骨折端愈合良好。平均随访时间16个月,末次随访时,膝关节功能采用美国特种外科医院膝关节评分标准(HSS):优9例,良4例,中2例,优良率为86.7%。结论对于胫骨平台骨折行双侧钢板内固定术后发生慢性感染的患者,一期仅取出感染侧钢板,联合VSD技术控制感染,骨折愈合后二期手术对侧内固定,控制感染效果满意,同时达到骨折愈合的目的,具有有效性和安全性。Objective To investigate the clinical efficacy of one-stage removal of the internal fixation on the infected side and two-stage removal of the contralateral internal fixation in the treatment of chronic infection after double-plate internal fixation for complex tibial plateau fractures.Methods A retrospective analysis was performed on 15 patients with complex tibial plateau fractures treated in Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from January 2012 to January 2020 who developed chronic infection after bilateral plate internal fixation in another hospital.There were 8 males and 7 females;the age ranged from 23 to 74 years old,with an average age of(59.3±14.3)years;and 13 cases were of Schatzker typeⅤand 2 cases were of typeⅥ.All patients had blurred fracture lines or callus formation when they came to the hospital.Then according to the microbial culture results of the patients'wound secretions,sensitive antibiotics were used for anti-infection treatment.In the first-stage operation,only the internal fixation plate on the infected side was removed,and the infection was controlled by combined VSD negative pressure drainage treatment.After the fracture was healed,the contralateral internal fixation plate was removed in the second-stage operation.Results After removal of the internal fixation plate on the infected side+wound closure negative pressure drainage(VSD)in all patients,the infection was satisfactorily controlled,and there was no recurrence of infection after surgery.After the fracture healed,the contralateral internal fixation plate was removed in the second-stage surgery.And there was no infection on the contralateral side before and after the operation,and the fracture end healed well.The average follow-up time was 16 months,and at the last follow-up,the knee joint function was evaluated according to the American Hospital for Special Surgery Knee Score(HSS):Excellent in 9 cases,good in 4 cases,and moderate in 2 cases,with an excellent and good rate of 86.7%.Conclusion In pa

关 键 词：复杂胫骨平台 慢性感染 单侧取出 双侧钢板内固定 

分 类 号：R683.42[医药卫生—骨科学]