Ilizarov骨搬移技术结合伤科黄水治疗胫骨骨折后感染性骨缺损的临床研究
发布时间：2019-01-10 10:35
【摘要】：目的:探讨Ilizarov技术结合伤科黄水治疗胫骨骨折创伤后感染性骨缺损的临床疗效方法:选取广东省佛山市中医院创伤骨科2014年6月-2016年6月收治的60例创伤后胫骨骨折感染性骨缺损患者为研究对象。其中男42例,女18例,年龄16-56岁,平均(41.2)岁,首次受伤均为开放性骨折,病程6-24月,平均14.6个月,骨缺损长度6-14.5cm,平均(8.8±1.2)cm.患者入院时均无全身感染症状,术前影像学检查、临床表现及实验室检查及细菌培养结果均提示不同程度感染性骨缺损。将60例患者随机分为四组,且经统计学检验性别、年龄分布及患者病程差异无统计学意义。A组观察组,术前术后均予以伤科黄水换药;B组术前黄水组,术后生理盐水组;C组术前生理盐水组,术后伤科黄水组;D组空白对照组,术前术后均予以生理盐水换药。所有患者术前均予以敏感型抗生素及控制感染情况并完善术前检查,排除手术禁忌症,待感染稳定后择期手术,手术采用Ilizarov外固定架截骨骨搬移技术,软组织缺损处行皮瓣转移或开放引流。并于术后10天开始以0.6-1mm/d的速度搬移骨块至缺损处。骨搬移结束后根据拍片骨质矿化情况予以拆除外固定架。比较四组钉道感染情况。结果:所有患者均顺利完成手术,手术时间平均(135±26.8)min;术中出血量平均(103±21.4)ml.36例患者均获得随访,随访时间9-24个月,骨搬移时间平均90(60-150)天,所有患者骨折全部愈合,愈合时间6-18(8.86±3.31)个月,骨感染也均得到控制.牵引成骨长度为:6-14.5cm,平均(8.8±1.2)cm。A组针道感染率为6.67%(1/15);B组针眼感染率为33.33%(5/15),C组针眼感染率为20%(3/15);D组针眼感染率为53.33%(8/15)。经统计学分析,四组比较有显著差异(P0.05),术前术后运用伤科黄水换药,能有效降低钉道感染率。9例于骨搬移过程中出现轴向偏移,予以调整后纠正;11例患者因钢针牵拉引起皮肤疼痛,予以停止牵引2-3日,待疼痛消失后再继续搬移。根据Paley骨折愈合评分标准,优37例,良14例,中9例;所有患者会师骨端愈合后,踝、膝关节功能均得到改善。结论:Illizarov技术结合伤科黄水治疗胫骨创伤后感染性骨缺损临床疗效显著,操作安全简单,且伤科黄水能有效降低术后钉道感染率,值得推广应用。
[Abstract]:Objective: to investigate the clinical effect of Ilizarov combined with yellow water in the treatment of infectious bone defect after tibial fracture: 60 cases of post-traumatic tibia treated in Department of traumatic Orthopedics, Foshan Hospital of traditional Chinese Medicine, Guangdong Province from June 2014 to June 2016 Patients with infectious bone defect of bone fracture were studied. There were 42 males and 18 females, aged 16-56 years (mean 41.2 years). The first injury was open fracture. The course of disease was 6-24 months (mean 14.6 months), the length of bone defect was 6-14.5 cm (mean 8.8 卤1.2) cm.. There were no systemic infection symptoms on admission. Preoperative imaging examination, clinical manifestation, laboratory examination and bacterial culture showed different degree of infectious bone defect. 60 patients were randomly divided into four groups, with no statistical significance in sex, age distribution and course of disease. Group C was treated with saline before and after operation, and group D was treated with saline before and after operation. All the patients were treated with sensitive antibiotics before operation and infection control. The preoperative examination was improved, the contraindication of operation was eliminated, the surgery was performed after the infection was stabilized, and the technique of osteotomy and removal with Ilizarov external fixator was used. Flap transfer or open drainage were performed at the soft tissue defect. The bone mass was removed to the defect at the rate of 0.6-1mm/d 10 days after operation. After bone removal, the external fixator was removed according to the status of bone mineralization. The infection of the nail passage was compared among the four groups. Results: all patients completed the operation successfully, and the average operation time was (135 卤26. 8) min;. The average amount of blood loss during operation was (103 卤21.4) ml.36. The follow-up time was 9-24 months and the average time of bone transfer was 90 (60-150) days. All the patients were healed, and the healing time was 6-18 (8.86 卤3.31) months. Bone infection was also controlled. The length of distraction osteogenesis was 6-14.5 cm (mean (8.8 卤1.2) cm.A) needle infection rate was 6.67% (1 / 15); B group was 33.33%) (5 / 15), C group was 20% (3 / 15); The needle infection rate in group D was 53.33% (8 / 15). According to statistical analysis, there was significant difference among the four groups (P0.05). Before and after operation, the infection rate of nail canal could be effectively reduced by using yellow water in injury department. 9 cases had axial deviation in the process of bone transfer, and were corrected after adjustment. 11 patients suffered from skin pain caused by steel needle pulling and stopped traction for 2-3 days, and then moved on after the pain disappeared. According to the Paley score of fracture healing, 37 cases were excellent, 14 cases were good, 9 cases were middle, all the patients had improved the function of ankle and knee joint after union of bone ends. Conclusion: Illizarov combined with yellow water in the treatment of infectious bone defect after tibia trauma is effective, safe and simple, and it can effectively reduce the infection rate of post operative nail canal, so it is worth popularizing.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2406211
[Abstract]:Objective: to investigate the clinical effect of Ilizarov combined with yellow water in the treatment of infectious bone defect after tibial fracture: 60 cases of post-traumatic tibia treated in Department of traumatic Orthopedics, Foshan Hospital of traditional Chinese Medicine, Guangdong Province from June 2014 to June 2016 Patients with infectious bone defect of bone fracture were studied. There were 42 males and 18 females, aged 16-56 years (mean 41.2 years). The first injury was open fracture. The course of disease was 6-24 months (mean 14.6 months), the length of bone defect was 6-14.5 cm (mean 8.8 卤1.2) cm.. There were no systemic infection symptoms on admission. Preoperative imaging examination, clinical manifestation, laboratory examination and bacterial culture showed different degree of infectious bone defect. 60 patients were randomly divided into four groups, with no statistical significance in sex, age distribution and course of disease. Group C was treated with saline before and after operation, and group D was treated with saline before and after operation. All the patients were treated with sensitive antibiotics before operation and infection control. The preoperative examination was improved, the contraindication of operation was eliminated, the surgery was performed after the infection was stabilized, and the technique of osteotomy and removal with Ilizarov external fixator was used. Flap transfer or open drainage were performed at the soft tissue defect. The bone mass was removed to the defect at the rate of 0.6-1mm/d 10 days after operation. After bone removal, the external fixator was removed according to the status of bone mineralization. The infection of the nail passage was compared among the four groups. Results: all patients completed the operation successfully, and the average operation time was (135 卤26. 8) min;. The average amount of blood loss during operation was (103 卤21.4) ml.36. The follow-up time was 9-24 months and the average time of bone transfer was 90 (60-150) days. All the patients were healed, and the healing time was 6-18 (8.86 卤3.31) months. Bone infection was also controlled. The length of distraction osteogenesis was 6-14.5 cm (mean (8.8 卤1.2) cm.A) needle infection rate was 6.67% (1 / 15); B group was 33.33%) (5 / 15), C group was 20% (3 / 15); The needle infection rate in group D was 53.33% (8 / 15). According to statistical analysis, there was significant difference among the four groups (P0.05). Before and after operation, the infection rate of nail canal could be effectively reduced by using yellow water in injury department. 9 cases had axial deviation in the process of bone transfer, and were corrected after adjustment. 11 patients suffered from skin pain caused by steel needle pulling and stopped traction for 2-3 days, and then moved on after the pain disappeared. According to the Paley score of fracture healing, 37 cases were excellent, 14 cases were good, 9 cases were middle, all the patients had improved the function of ankle and knee joint after union of bone ends. Conclusion: Illizarov combined with yellow water in the treatment of infectious bone defect after tibia trauma is effective, safe and simple, and it can effectively reduce the infection rate of post operative nail canal, so it is worth popularizing.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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