不同外科治疗方案在胫骨平台骨折不愈并发慢性感染患者中的疗效

发布时间：2018-03-06 06:17

本文选题：锁定钢板内固定　切入点：髓内钉内固定　出处：《中华医院感染学杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨不同外科治疗方案在胫骨平台骨折不愈并发慢性感染患者中的疗效,为提升胫骨平台骨折不愈并发慢性感染患者临床疗效提供科学依据。方法选取医院骨科收治的胫骨平台骨折不愈并发慢性感染患者154例,分为对照组和研究组,每组77例,对照组给予锁定钢板内固定,研究组给予髓内钉内固定,比较两组患者的一般治疗情况,术后并发症,膝关节功能及骨痂生长情况,统计术前病原菌的分布和术后感染病原菌的分布情况。结果研究组患者手术时间、骨折愈合时间、创面愈合时间以及住院天数均低于对照组,差异有统计学意义(P0.05);研究组患者术后感染,关节伸直受限,断针,骨不连的比例低于对照组,差异具有统计学意义;对照组分离培养出病原菌86株,革兰阳性菌占58.4%,革兰阴性菌占37.1%,真菌4.5%,研究组分离出病原菌89株,革兰阳性菌占61.6%,革兰阴性菌占34.9%,真菌3.5%;治疗后对照组分离培养出13株病原菌,革兰阴性菌占61.5%,革兰阳性菌占30.8%,真菌7.7%,研究组分离出病原菌3株,革兰阴性菌66.7%,真菌33.3%;治疗后,与治疗前相比,两组患者膝关节功能和骨痂生长评分均有明显提升,观察组患者膝关节功能和骨痂生长评分显著高于对照组,差异有统计学意义(P0.05)。结论与锁定钢板内固定相比,髓内钉内固定可以有效地提升胫骨平台骨折不愈合并发慢性感染的患者的总体疗效,降低术后并发症。
[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.
【作者单位】：攀枝花市第二人民医院骨外科;
【基金】：四川省卫生医药科技计划基金资助项目(201537429)
【分类号】：R687.3

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