摘要
目的对比分析胫骨骨折内固定术后感染的早期清创置入物取出及延期置入物取出的疗效。方法采用回顾性病例对照研究分析2005年3月-2016年9月27例同济大学附属东方医院收治的27例行胫骨骨折接骨板或螺钉内固定术后感染患者临床资料，其中男21例，女6例；年龄18～81岁[（41．6±14．3）岁]。按照治疗方法不同，分为延期置入物取出组（A组，10例）和早期清创置入物取出组（B组，17例）。A组予以清创、抗感染及持续更换敷料，待骨折愈合后再取出置入物。B组予以抗感染及持续更换敷料1个月后，感染未见明显控制时即实施清创及置入物取出术。骨折端稳定者术后仅给予负压封闭引流（VSD），不稳定者给予外固定架固定、VSD。比较两组感染至置入物取出时间、感染控制时间、骨折不愈合发生率、慢性骨感染发生率、美国特种外科医院（HSS）膝关节功能评分及美国足踝外科协会（AOFAS）踝-后足评分。结果27例患者均获随访13～47个月，平均28．4个月。A组和B组感染至置入物取出时间[（49．9±17．1）周：（19．3±9．2）周]、感染控制时间[（85．3±78．3）d：（6．3±2．8）d]、骨折不愈合率（30％：O）及慢性骨感染发生率（30％：0）方面差异均有统计学意义（P〈0．05）。两组在HSS膝关节功能评分及AOFAS踝-后足评分方面差异无统计学意义（P〉0．05）。结论对于胫骨骨折内固定术后感染患者，早期彻底清创及置入物取出能较快地控制感染，降低骨折不愈合及骨感染发生率。
Objective To compare the efficacy of early and delayed removal of debridement implant for infection after internal fixation of tibial fracture. Methods A retrospective case control study was conducted on the clinical data of 27 patients with tibial fractures who received plate or screw internal fixation admitted to the East Hospital Affiliated to Tongji University from March 2005 to September 2016. There were 21 males and six females, aged 18-81 years [ （41.6 ± 14. 3 ）years]. According to the treatment methods, the patients were divided into the delayed implant removal group （Group A, 10 patients） and the ear/y implant removal group （Group B, 17 patients）. Group A was given debridement and anti infection treatment followed by continuous dressing change, and the implant was removed after the fractures were healed. Group B was given debridement and implant removal after one month of anti infection treatment and continuous dressing change when the infection was not clearly controlled. Patients with stable fracture ends were given only negative pressure closed drainage （VSD） , and those with instable fracture ends were given external fixation and VSD. The time from infection to implant removal, the time of infection control, the fracture nonunion rate, the chronic bone infection rate,the knee joint function score of the American Hospital for Special Surgery （HSS） , and the American Orthopedic Foot and Ankle Society （AOFAS） ankle hindfoot scale were compared between the two groups. Results All patients were followed up for 13-47 months, with the average of 28.4 months. There were significant differences between Group A and Group B in terms of the time from infection to implant removal [ （49.9 ± 17.1 ）weeks ： （ 19.3 ±9.2）weeks], the time of infection control [ （85.3 ± 78.3） days ： （6.3 ± 2. 8 ） days ], fracture nonunion rate （ 30% ： 0 ）, and the chronic osteomyelitis incidence （30% ： 0） （all P 〈 0.05 ）. No significant differences were found in HSS knee
作者
韩庆辉
张坤
陈雁西
强敏菲
贾小阳
唐小莹
Han Qinghui;Zhang Kun;Chen Yanxi;Qiang Minfei;Jia Xiaoyang;Tang Xiaoying(Department of Orthopedic Trauma,East Hospital of Tongji University,Shanghai 200120,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第11期995-1000,共6页
Chinese Journal of Trauma
关键词
胫骨骨折
骨折固定术
内
骨疾病
感染性
装置取出
Tibial fractures
Fracture fixation
internal
Bone diseases
infectious
Device removal
