胫腓骨开放性骨折患者术后感染病原菌分布及VSD治疗对微循环与相关血清细胞因子指标水平的影响

发布时间：2018-12-14 15:42

【摘要】：目的研究分析胫腓骨开放性骨折患者术后感染病原菌情况及应用负压封闭引流技术(VSD)治疗后患者的血清细胞因子指标水平变化及对患肢微循环恢复作用。方法选取2014年1月-2017年1月医院收治的胫腓骨开放性骨折术后出现感染者62例为A组;另选取同期开放性胫腓骨骨折术后未感染者62例为B组;两组均行内固定或外固定支架治疗,根据术后骨折感染的治疗方法不同将A组分为A1、A2患者各31例,A2患者术后行抗感染药物常规治疗,同时行骨折创面消毒及无菌敷料更换等,A1患者行VSD治疗;观察骨折术后感染的病原菌分布;比较分析A、B两组的细胞间黏附因子-1、可溶性血管细胞黏附因子-1、核因子KB的指标水平;比较A1、A2患者的相关指标水平检测,同时评估临床疗效。结果 62例感染患者共分离出病原菌119株,以革兰阳性菌73株占61.34%为主;治疗后2d、4d、6d,A1患者的流态积分、管襻积分、襻周积分、总积分、白微栓率、管襻畸形率低于A2组,而A1组的襻顶血管直径、管襻长度均高于A2组(P0.05)。结论对于开放性胫腓骨骨折术后感染患者行VSD治疗,可有效清除骨折区域坏死组织及控制感染,对创面的愈合、肢体微循环修复作用显著。
[Abstract]:Objective to study the pathogenic bacteria of postoperative infection in patients with open tibia and fibula fracture, and to study the changes of serum cytokines in patients with open tibia and fibula fracture after (VSD) treatment and their effect on recovery of microcirculation in affected limbs. Methods from January 2014 to January 2017, 62 patients with open tibia and fibula fractures were selected as group A, 62 patients without infection after open tibia and fibula fractures were selected as group B, and 62 patients with open tibia and fibula fractures after operation were selected as group A and group B respectively. Both groups were treated with internal fixation or external fixation stents. According to the different treatment methods of postoperative fracture infection, group A was divided into two groups: group A (31 cases), A 2 patients were treated with routine anti-infective drugs after operation. At the same time, the fracture wound was disinfected and the sterile dressing was replaced. A1 patients were treated with VSD. To observe the distribution of pathogenic bacteria of infection after fracture, to compare and analyze the levels of intercellular adhesion factor-1, soluble vascular cell adhesion factor-1 and nuclear factor KB in group A and B; To compare the level of relevant indexes in A 1 A 2 patients and evaluate the clinical efficacy. Results A total of 119 strains of pathogenic bacteria were isolated from 62 infected patients, 73 of which were Gram-positive bacteria (61.34%). The flow state integral, loop integral, cycle integral, total integral, white microembolism rate and abnormal rate of loop in group A1 were lower than those in group A 2, while the diameter and length of loop loops in group A1 were higher than those in group A2 (P0.05). Conclusion VSD can effectively remove the necrotic tissue and control the infection of the patients with open tibia and fibula fracture after operation. It has a significant effect on wound healing and limb microcirculation repair.
【作者单位】：武警浙江总队杭州医院骨一科;武警浙江总队杭州医院检验科;
【基金】：浙江省中医药科技计划基金资助项目(2014ZB124)
【分类号】：R687.3

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