本文選題：鎖定鋼板內(nèi)固定　切入點(diǎn)：髓內(nèi)釘內(nèi)固定　出處：《中華醫(yī)院感染學(xué)雜志》2017年06期 　論文類(lèi)型：期刊論文

【摘要】：目的探討不同外科治療方案在脛骨平臺(tái)骨折不愈并發(fā)慢性感染患者中的療效,為提升脛骨平臺(tái)骨折不愈并發(fā)慢性感染患者臨床療效提供科學(xué)依據(jù)。方法選取醫(yī)院骨科收治的脛骨平臺(tái)骨折不愈并發(fā)慢性感染患者154例,分為對(duì)照組和研究組,每組77例,對(duì)照組給予鎖定鋼板內(nèi)固定,研究組給予髓內(nèi)釘內(nèi)固定,比較兩組患者的一般治療情況,術(shù)后并發(fā)癥,膝關(guān)節(jié)功能及骨痂生長(zhǎng)情況,統(tǒng)計(jì)術(shù)前病原菌的分布和術(shù)后感染病原菌的分布情況。結(jié)果研究組患者手術(shù)時(shí)間、骨折愈合時(shí)間、創(chuàng)面愈合時(shí)間以及住院天數(shù)均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);研究組患者術(shù)后感染,關(guān)節(jié)伸直受限,斷針,骨不連的比例低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義;對(duì)照組分離培養(yǎng)出病原菌86株,革蘭陽(yáng)性菌占58.4%,革蘭陰性菌占37.1%,真菌4.5%,研究組分離出病原菌89株,革蘭陽(yáng)性菌占61.6%,革蘭陰性菌占34.9%,真菌3.5%;治療后對(duì)照組分離培養(yǎng)出13株病原菌,革蘭陰性菌占61.5%,革蘭陽(yáng)性菌占30.8%,真菌7.7%,研究組分離出病原菌3株,革蘭陰性菌66.7%,真菌33.3%;治療后,與治療前相比,兩組患者膝關(guān)節(jié)功能和骨痂生長(zhǎng)評(píng)分均有明顯提升,觀察組患者膝關(guān)節(jié)功能和骨痂生長(zhǎng)評(píng)分顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論與鎖定鋼板內(nèi)固定相比,髓內(nèi)釘內(nèi)固定可以有效地提升脛骨平臺(tái)骨折不愈合并發(fā)慢性感染的患者的總體療效,降低術(shù)后并發(fā)癥。
[Abstract]:Objective to investigate the effect of different surgical treatment in patients with chronic infection of tibial plateau fracture. Methods 154 cases of tibial plateau fracture with chronic infection were selected and divided into control group and study group, 77 cases in each group. The control group was treated with locking plate and the study group with intramedullary nail fixation. The general treatment, postoperative complications, knee joint function and callus growth were compared between the two groups. Results the operative time, fracture healing time, wound healing time and hospital stay in the study group were lower than those in the control group. The rate of infection, limited joint extension, broken needle and bone nonunion in the study group was lower than that in the control group (P 0.05). 86 strains of pathogenic bacteria were isolated and cultured in the control group. Gram-positive bacteria accounted for 58.4%, Gram-negative bacteria 37.1%, fungi 4.5.The study group isolated 89 strains of pathogens, 61.6% of gram-positive bacteria, 34.9m of Gram-negative bacteria, 3.5% of fungi. After treatment, 13 pathogenic bacteria were isolated and cultured in the control group. Gram-negative bacteria accounted for 61.5%, Gram-positive bacteria for 30.8 and fungi for 7.7.The study group isolated 3 pathogenic bacteria, 66.7 Gram-negative bacteria, and 33.3 fungi. After treatment, the knee joint function and callus growth score of the two groups were significantly improved compared with those before treatment. The knee joint function and callus growth score in the observation group were significantly higher than those in the control group (P 0.05). Conclusion compared with locking plate fixation, the knee joint function and callus growth score in the observation group were significantly higher than those in the control group. Intramedullary nail fixation can effectively improve the overall efficacy of nonunion of tibial plateau fractures with chronic infection and reduce postoperative complications.
【作者單位】： 攀枝花市第二人民醫(yī)院骨外科;
【基金】：四川省衛(wèi)生醫(yī)藥科技計(jì)劃基金資助項(xiàng)目(201537429)
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：1573661