【摘要】：目的:探討Ilizarov技術(shù)結(jié)合傷科黃水治療脛骨骨折創(chuàng)傷后感染性骨缺損的臨床療效方法:選取廣東省佛山市中醫(yī)院創(chuàng)傷骨科2014年6月-2016年6月收治的60例創(chuàng)傷后脛骨骨折感染性骨缺損患者為研究對象。其中男42例,女18例,年齡16-56歲,平均(41.2)歲,首次受傷均為開放性骨折,病程6-24月,平均14.6個月,骨缺損長度6-14.5cm,平均(8.8±1.2)cm.患者入院時均無全身感染癥狀,術(shù)前影像學(xué)檢查、臨床表現(xiàn)及實(shí)驗(yàn)室檢查及細(xì)菌培養(yǎng)結(jié)果均提示不同程度感染性骨缺損。將60例患者隨機(jī)分為四組,且經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)性別、年齡分布及患者病程差異無統(tǒng)計(jì)學(xué)意義。A組觀察組,術(shù)前術(shù)后均予以傷科黃水換藥;B組術(shù)前黃水組,術(shù)后生理鹽水組;C組術(shù)前生理鹽水組,術(shù)后傷科黃水組;D組空白對照組,術(shù)前術(shù)后均予以生理鹽水換藥。所有患者術(shù)前均予以敏感型抗生素及控制感染情況并完善術(shù)前檢查,排除手術(shù)禁忌癥,待感染穩(wěn)定后擇期手術(shù),手術(shù)采用Ilizarov外固定架截骨骨搬移技術(shù),軟組織缺損處行皮瓣轉(zhuǎn)移或開放引流。并于術(shù)后10天開始以0.6-1mm/d的速度搬移骨塊至缺損處。骨搬移結(jié)束后根據(jù)拍片骨質(zhì)礦化情況予以拆除外固定架。比較四組釘?shù)栏腥厩闆r。結(jié)果:所有患者均順利完成手術(shù),手術(shù)時間平均(135±26.8)min;術(shù)中出血量平均(103±21.4)ml.36例患者均獲得隨訪,隨訪時間9-24個月,骨搬移時間平均90(60-150)天,所有患者骨折全部愈合,愈合時間6-18(8.86±3.31)個月,骨感染也均得到控制.牽引成骨長度為:6-14.5cm,平均(8.8±1.2)cm。A組針道感染率為6.67%(1/15);B組針眼感染率為33.33%(5/15),C組針眼感染率為20%(3/15);D組針眼感染率為53.33%(8/15)。經(jīng)統(tǒng)計(jì)學(xué)分析,四組比較有顯著差異(P0.05),術(shù)前術(shù)后運(yùn)用傷科黃水換藥,能有效降低釘?shù)栏腥韭省?例于骨搬移過程中出現(xiàn)軸向偏移,予以調(diào)整后糾正;11例患者因鋼針牽拉引起皮膚疼痛,予以停止?fàn)恳?-3日,待疼痛消失后再繼續(xù)搬移。根據(jù)Paley骨折愈合評分標(biāo)準(zhǔn),優(yōu)37例,良14例,中9例;所有患者會師骨端愈合后,踝、膝關(guān)節(jié)功能均得到改善。結(jié)論:Illizarov技術(shù)結(jié)合傷科黃水治療脛骨創(chuàng)傷后感染性骨缺損臨床療效顯著,操作安全簡單,且傷科黃水能有效降低術(shù)后釘?shù)栏腥韭?值得推廣應(yīng)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 鹵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 鹵26. 8) min;. The average amount of blood loss during operation was (103 鹵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 鹵3.31) months. Bone infection was also controlled. The length of distraction osteogenesis was 6-14.5 cm (mean (8.8 鹵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.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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