本文選題：開放性脛骨骨折 + 感染��； 參考：《中國(guó)修復(fù)重建外科雜志》2017年06期

【摘要】：目的評(píng)估開放性脛骨骨折自外支架更換為內(nèi)固定的安全性。方法回顧分析2010年1月—2014年12月收治并符合選擇標(biāo)準(zhǔn)的94例(98側(cè)患肢)以外支架為初期固定手段的開放性脛骨骨折患者資料。其中29例(31側(cè)患肢)由于患者主觀不適、釘?shù)婪磻?yīng)、Schantz針?biāo)蓜?dòng)及延遲愈合或不愈合等原因,在傷口愈合及紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)、C反應(yīng)蛋白(C reactive protein,CRP)、白細(xì)胞絕對(duì)計(jì)數(shù)及中性粒細(xì)胞比例降至正�；蚪咏７秶�,更換為內(nèi)固定(試驗(yàn)組);65例(67側(cè)患肢)未更換為內(nèi)固定(對(duì)照組)。兩組患者性別、年齡、側(cè)別、受傷至第1次清創(chuàng)時(shí)間、初始病原菌類型、接受植皮或皮瓣移位修復(fù)肢體數(shù)等一般資料比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);但對(duì)照組GustiloⅢ型患者比例明顯高于試驗(yàn)組,兩組骨折分型比較差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。計(jì)算兩組患者總體感染發(fā)生率;分別比較兩組不同骨折分型患者以及接受過植皮或皮瓣移位手術(shù)患者的感染發(fā)生率;記錄感染患者病原菌信息,并與初始病原菌進(jìn)行比較;記錄試驗(yàn)組患者使用不同內(nèi)固定物發(fā)生感染情況。結(jié)果試驗(yàn)組和對(duì)照組總體感染發(fā)生率分別為9.7%(3/31)和9.0%(6/67),比較差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.013,P=0.909)。Ⅰ、Ⅱ型患者均未發(fā)生感染;試驗(yàn)組和對(duì)照組ⅢA型患者感染發(fā)生率分別為14.3%(1/7)和6.3%(2/32),ⅢB型分別為50.0%(2/4)和14.3%(2/14),ⅢC型分別為0和16.7%(2/12),比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.509,P=0.476;χ2=2.168,P=0.141;χ2=0.361,P=0.548)。發(fā)生感染的患肢中,僅試驗(yàn)組1側(cè)金黃色葡萄球菌與術(shù)前原始致病菌一致。接受植皮或皮瓣移位手術(shù)的患者中,試驗(yàn)組和對(duì)照組感染發(fā)生率分別為33.3%(2/6)和13.3%(2/15),比較差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.059,P=0.303)。試驗(yàn)組更換為內(nèi)固定后,采用髓內(nèi)釘者(11側(cè))無(wú)1例發(fā)生感染,而采用鋼板(20側(cè))的患者中4側(cè)發(fā)生感染,感染發(fā)生率為20%。結(jié)論多數(shù)情況下,開放性脛骨骨折患者自外支架更換為內(nèi)固定是安全的。但針對(duì)初始創(chuàng)傷伴廣泛而嚴(yán)重軟組織損傷者,特別是GustiloⅢ型骨折且通過皮瓣或植皮修復(fù)獲得創(chuàng)面愈合者,術(shù)前必須仔細(xì)評(píng)估患者軟組織條件,謹(jǐn)慎選擇內(nèi)固定物類型,術(shù)中對(duì)軟組織進(jìn)行精細(xì)保護(hù)。
[Abstract]:Objective to evaluate the safety of internal fixation for open tibial fractures. Methods the data of 94 patients with open tibial fractures treated from January 2010 to December 2014 who met the selection criteria were retrospectively analyzed. 29 cases (31 sides of the affected limbs) were caused by the subjective discomfort, the reaction of the nail path, the loosening of the Schantz needle and the delayed healing or non-union, etc. After wound healing and erythrocyte sedimentation rate (erythrocyte sedimentation), C reactive protein (CRP), absolute white blood cell count and neutrophil ratio were reduced to normal or near normal range. 65 cases (67 sides of affected limbs) were not replaced with internal fixation (control group). Sex, age, side type, time from injury to the first debridement, initial pathogen type, number of limbs repaired by skin graft or skin flap were compared between the two groups. There was no significant difference between the two groups (P0.05), but the proportion of Gustilo 鈪，

本文編號(hào)：2081290