持续灌洗引流联合病灶清除术治疗小儿骨关节化脓性感染的临床研究  

Continuous irrigation and drainage combined with lesion debridement surgery for the treatment of purulent bone and joint infections in children

作　　者：刘子祥 戴蓉丹 朱海佳 王凯 王浩然 Liu Zixiang;Dai Rongdan;Zhu Haijia;Wang Kai;Wang Haoran(Department of Orthopedics,Hangzhou Children's Hospital,Hangzhou 310004,Zhejiang Province,China)

机构地区：[1]杭州市儿童医院骨科,杭州310004

出　　处：《中国基层医药》2024年第8期1178-1182,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省杭州市生物医药和健康产业发展扶持科技计划(2022WJC169)。

摘　　要：目的探讨持续灌洗引流联合病灶清除术治疗小儿骨关节化脓性感染的效果。方法采用病例对照研究,回顾性分析杭州市儿童医院2021年1月至2022年10月收治的骨关节化脓性感染患儿76例的临床资料,依据治疗方法不同分为对照组、观察组各38例。对照组采用病灶清除术治疗,观察组采用持续灌洗引流联合病灶清除术治疗。比较两组临床效果。结果观察组总有效率为97.37%(37/38),高于对照组的76.32%(29/38)(χ^(2)=7.36,P<0.05)。治疗后,观察组白细胞计数、红细胞沉降率、中性粒细胞百分比分别为(4.32±0.95)×10^(9)/L、(14.20±2.50)mm/h、(52.12±8.45)%,均低于对照组的(5.68±1.02)×10^(9)/L、(22.35±3.35)mm/h、(66.65±6.20)%(t=6.01、12.01、8.54,均P<0.05);观察组白细胞介素6、C反应蛋白、降钙素原、肿瘤坏死因子α分别为(5.20±1.02)ng/L、(8.20±1.11)mg/L、(0.80±0.12)μg/L、(3.20±1.02)ng/L,均低于对照组的(8.12±1.10)ng/L、(14.34±2.20)mg/L、(1.12±0.20)μg/L、(7.50±1.12)ng/L(t=11.99、15.36、8.45、17.49,均P<0.05)。治疗后1周、1个月、3个月,观察组视觉模拟评分法评分均低于对照组(t=3.14、2.33、11.36,均P<0.05)。观察组复发率为2.63%(1/38),低于对照组的21.05%(8/38))(χ^(2)=4.53,P<0.05)。结论持续灌洗引流联合病灶清除术治疗小儿骨关节化脓性感染效果更好,能减轻炎症反应,缓解疼痛,复发率低。Objective To investigate the efficacy of continuous irrigation and drainage combined with lesion debridement surgery in the treatment of purulent bone and joint infections in children.Methods A case-control study was conducted to retrospectively analyze the clinical data of 76 children with purulent bone and joint infections who received treatment at Hangzhou Children's Hospital from January 2021 to October 2022.Based on different treatment methods,these children were divided into a control group and an observation group,with 38 cases in each group.The control group received lesion debridement surgery,while the observation group underwent continuous irrigation and drainage combined with lesion debridement surgery.The clinical outcomes of the two groups were compared.Results The total response rate in the observation group was 97.37%(37/38),which was significantly higher than that in the control group[76.32%(29/38),χ^(2)=7.36,P<0.05].After treatment,the white blood cell count,erythrocyte sedimentation rate,and percentage of neutrophils in the observation group were(4.32±0.95)×10^(9)/L,(14.20±2.50)mm/h,and(52.12±8.45)%,respectively,all of which were significantly lower than those in the control group[(5.68±1.02)×10^(9)/L,(22.35±3.35)mm/h,and(66.65±6.20)%,t=6.01,12.01,8.54,all P<0.05].The levels of interleukin-6,C-reactive protein,procalcitonin,and tumor necrosis factor-αin the observation group were(5.20±1.02)ng/L,(8.20±1.11)mg/L,(0.80±0.12)μg/L,and(3.20±1.02)ng/L,respectively,which were significantly lower than those in the control group[(8.12±1.10)ng/L,(14.34±2.20)mg/L,(1.12±0.20)μg/L,and(7.50±1.12)ng/L,t=11.99,15.36,8.45,17.49,all P<0.05).At 1 week,1 month,and 3 months after treatment,the Visual Analog Scale scores in the observation group were significantly lower than those in the control group(t=3.14,2.33,11.36,all P<0.05).The recurrence rate in the observation group was significantly lower than that in the control group[2.63%(1/38)vs.21.05%(8/38),χ^(2)=4.53,P<0.05).Conclusion Continuous i

关 键 词：骨关节炎 关节炎 感染性 灌洗疗法 引流术 白细胞 白细胞介素6 C反应蛋白质 儿童 

分 类 号：R726.8[医药卫生—儿科]