VSD治疗对胫骨骨折术后继发骨感染患者手术指标、炎性因子及功能恢复的影响  

Effect of VSD treatment on surgical indicators,inflammatory factors and functional recovery in patients with secondary bone infection after tibial fracture surgery

作　　者：鹿青[1] 潘振华[1] 刘莉 寇玉婷 聂晓腾 李玉佳 邢文钊[1] LU Qing;PAN Zhenhua;LIU Li;KOU Yuting;NIE Xiaoteng;LI Yujia;XING Wenzhao(Department of Orthopedics and Traumatology,the Third Hospital of Hebei Medical University,Shijiazhuang,Hebei,China,050051;Sports Medicine Preparatory Office of Hebei Medical University,Shijiazhuang,Hebei,China,050051)

机构地区：[1]河北医科大学第三医院骨伤科,河北石家庄050051 [2]河北医科大学运动医学筹备办公室,河北石家庄050051

出　　处：《分子诊断与治疗杂志》2024年第1期27-31,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河北省医学科学研究计划项目(20201033)。

摘　　要：目的探讨负压封闭引流技术(VSD)治疗对胫骨骨折术后继发骨感染患者手术指标、炎性因子、功能恢复的影响。方法选取2020年12月至2022年6月河北医科大学第三医院收治的87例胫骨骨折内固定术后继发骨感染患者,均为胫骨干骨折;其中原开放骨折55例,一期均缝合伤口;32例在外伤发生时一期清创后行内固定手术;对患者采用手术清创、去除内固定物,行外固定架固定,经清创后局部均存在创面不能完全闭合,合并骨外露,随机选用VSD覆盖治疗(研究组,n=46)或骨水泥覆盖治疗(对照组,n=41),分析患者病原菌构成分布、比较两组手术指标、炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平]、功能恢复情况[膝关节、踝关节功能以及肢体功能恢复情况]以及并发症情况。结果87例患者共87株病原菌,其中革兰阳性菌43株(49.42%),革兰阴性菌32株(36.78%),真菌12株(13.80%)。研究组换药次数少于对照组,控制感染时间、创面无菌时长、住院时间、行皮瓣转移手术时间均短于对照组,差异均有统计学意义(P<0.05);治疗后两组TNF-α、IL-6、CRP水平均下降,其中研究组变化最为显著,差异有统计学意义(P<0.05);治疗后两组HSS、Baird-Jackson评分均上升,其中研究组变化最为显著,差异有统计学意义(P<0.05)。研究组优良率为(95.65%)高于对照组优良率(80.49%),差异有统计学意义(P<0.05)。结论在创面不能闭合情况下,VSD治疗胫骨骨折内固定术后继发骨感染患者,可改善患者手术指标、炎性因子水平,促进患者肢体功能恢复,值得临床推广应用。Objective To investigate the effect of vacuum sealing drainage(VSD)treatment on surgical indicators,inflammatory factors,and functional recovery in patients with chronic osteomyelitis secondary to open tibial fractures.Methods 87 patients with secondary bone infection after internal fixation of tibial fracture treated in the Third Hospital of Hebei Medical University from December 2020 to June 2022 were selected,all of whom were tibial shaft fractures.55 cases of primary open fracture were sutured in the first stage;32 cases underwent internal fixation after primary debridement at the time of trauma;the patients were treated with surgical debridement,removal of internal fixation,and fixation with external fixation frame.After debridement,local wounds could not be completely closed,complicated with exposed bone,and VSD covering treatment(study group,n=46)or bone cement covering treatment(control group,n=41)were randomly selected,the distribution of pathogenic bacteria,surgical indicators,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)levels],functional recovery[knee,ankle and limb function recovery]and complications were summarized.Results There were 87 pathogenic bacteria in 87 patients,including 43 Gram-positive bacteria(49.42%),32 Gram-negative bacteria(36.78%),and 12 fungi(13.80%).The number of dressing changes in the study group was less than that in the control group,and the infection control time,wound sterility time,hospitalization time,and skin flap transfer operation time in the study group were shorter than those in the control group,and the difference was statistically significant(P<0.05).After treatment,the levels of TNF-α,IL-6,and CRP in the two groups decreased,among which the change in the study group was the most significant,and the difference was statistically significant(P<0.05).After treatment,the HSS and Baird-Jackson scores of the two groups increased,among which the change in the study group was the most significant,and the difference was st

关 键 词：VSD 胫骨骨折继发骨感染 病原菌分布 炎性因子 

分 类 号：R687.3[医药卫生—骨科学]