灌洗负压引流在儿童急性血源性骨髓炎开窗减压加病灶清除术中的应用  

Application of continuous douche plus vacuum drainage for acute hematogenous osteomyelitis in children with fenestration decompression and lesion clearance

作　　者：王怀铿 黄少敏 梁龙芳 檀鲁健 裴新红 Wang Huaikeng;Huang Shaomin;Liang Longfang;Tan Lujian;Pei Xinhong(Department of Orthopedics,Xiamen Children's Hospital,Xiamen 361000,China;Department of Nursing,Xiamen Children's Hospital,Xiamen 361000,China;Department of Orthopedics,Children's Hospital of Fudan University,Shanghai 201100,China)

机构地区：[1]厦门市儿童医院骨科,厦门361000 [2]厦门市儿童医院护理部,厦门361000 [3]复旦大学附属儿科医院骨科,上海201100

出　　处：《临床小儿外科杂志》2024年第8期757-762,共6页Journal of Clinical Pediatric Surgery

基　　金：厦门市医疗卫生指导性项目(3502Z202142ZD1246)。

摘　　要：目的探讨灌洗负压引流在儿童急性血源性骨髓炎(acute hematogenous osteomyelitis,AHO)开窗减压加病灶清除术中的应用价值。方法回顾性分析厦门市儿童医院2015年7月至2022年12月收治的AHO患儿临床资料,按术后是否行灌洗负压引流将患儿分为开窗减压+病灶清除+灌洗负压引流组(术式Ⅰ组,17例)及开窗减压+病灶清除组(术式Ⅱ组,18例)。对比分析两组发热持续时间,住院天数,引流管留置时间,术后白细胞计数、C反应蛋白、降钙素原及血沉水平转为正常的时间,术后有无复发,以及有无慢性骨髓炎、病理性骨折、切口感染等并发症情况。结果术式Ⅰ组引流管留置时间[(8.59±1.33)d]长于术式Ⅱ组[(6.28±1.27)d],差异有统计学意义(t=5.256,P<0.001)。术式Ⅰ组较术式Ⅱ组发热持续时间[(5.20±5.11)d比(4.06±5.79)d,t=0.616]、住院天数[(21.32±9.12)d比(23.11±10.30)d,t=-0.543]、术后白细胞降至正常时间[(5.21±4.93)d比(4.78±4.67)d,t=0.265]、C反应蛋白降至正常时间[(6.23±4.15)d比(5.61±3.37)d,t=0.486]、降钙素原降至正常时间[(8.15±7.25)d比(10.89±10.25)d,t=-0.908]、血沉降至正常时间[(23.87±12.56)d比(21.00±13.33)d,t=0.655]、骨髓炎复发率[(1/17,5.89%)比(2/18,11.11%)]、切口感染发生率[(1/17,5.89%)比(1/18,5.56%)]比较,差异均无统计学意义(P>0.05)。两组均无一例出现慢性骨髓炎及病理性骨折。术式Ⅰ组疗效优良率(16/17)与术式Ⅱ组(16/18)比较,差异无统计学意义(P>0.05)。结论灌洗负压引流不能提高AHO开窗减压加病灶刮除术的临床效果,反而延长引流管留置时间。因此,对于AHO患儿可以单纯采取开窗减压加病灶刮除术治疗,无需行灌洗负压引流。Objective To explore clinical value of continuous douche plus vacuum drainage in children with acute hematogenous osteomyelitis(AHO)after operation.Methods From July 2015 to December 2022,the relevant clinical data were retrospectively reviewed for AHO children hospitalized into Xiamen Children's Hospital.They were divided into two groups of fenestration decompression+lesion clearance+continuous douche plus vacuum drainage(Ⅰ,n=17)and fenestration decompression+lesion clearance(Ⅱ,n=18)according to whether or not continuous douche plus vacuum drainage post-operation was performed.The differences in duration of fever,length of hospitalization stay,indwelling time of drainage tube,postoperative time for white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT)and erythrocyte sedimentation rate(ESR)to normalize,postoperative recurrence rate of osteomyelitis,chronic osteomyelitis,pathological fracture,incision infection rate and postoperative efficacy were compared between two groups.Results Indwelling time of drainage tube was longer in groupⅠthan that in groupⅡ[(8.59±1.33)vs.(6.28±1.27)day]and the difference was statistically significant(t=5.256,P=0.000).No significant differences existed in duration of fever[(5.20±5.11)vs.(4.06±5.79)day,t=0.616],length of hospitalization stay[(21.32±9.12)vs.(23.11±10.30)day,t=-0.543],postoperative time for WBC to normalize(5.21±4.93 vs.4.78±4.67 day,t=0.265),time for CRP to normalize(6.23±4.15 vs.5.61±3.37 day,t=0.486),postoperative time for PCT to normalize[(8.15±7.25)vs.10.89±10.25 days,t=-0.908),postoperative time for ESR to normalize[(23.87±12.56)vs.(21.00±13.33)day,t=0.655],postoperative recurrence rate of osteomyelitis(1/17,5.89%vs.2/18,11.11%)and incision infection rate(1/17,5.89%vs.1/18,5.56%)(P>0.05).There was no instance of chronic osteomyelitis or pathological fracture.No significant inter-group difference in excellent/decent rate of efficacy evaluation[(16/17,94.12%)vs.(16/18,88.89%),P=1.000].Conclusions Continuous douche plus vacuum drainage

关 键 词：骨髓炎 清创术 引流术 儿童 

分 类 号：R47[医药卫生—护理学]