应用改良双套管脉冲持续冲洗结合负压封闭引流技术治疗骨髓炎

摘要

目的 探讨改良双套管脉冲持续冲洗结合负压封闭引流技术(vacuum sealing drainage,VSD)在治疗骨折术后继发骨髓炎的临床应用价值.方法 回顾性分析自2016年1月至2017年1月我院收治的25例骨折术后继发骨髓炎病人资料,行常规病灶清除术.根据术后处理方式分为两组:改良组15例采用双套管脉冲冲洗结合VSD持续引流7 d,对照组10例持续灌洗引流14 d.比较两组疗效评价指标,包括:红细胞沉降率和C反应蛋白水平变化,手术时间、住院时间、换药次数、局部炎症消退时间及复发率等.结果 改良组手术时间为(52.2±8.7)min,与对照组的(50.4±10.6)min比较,差异没有统计学意义(P=0.646).改良组的住院时间为(19.1±2.8)d、术后换药次数为(7.3±1.5)次、局部炎症反应消退时间为(24.9±2.6)d,优于对照组的(24.9±4.7)d、(21.8±4.5)次、(30.8±4.8)d,差异均有统计学意义(均P<0.05).改良组红细胞沉降率和C反应蛋白水平在术后7 d、14 d均优于对照组,差异均有统计学意义(均P<0.05);术后3个月起接近或达到正常水平.两组病人均一期愈合,均无复发病例.术后6个月内,两组病人骨折愈合良好,均未发生再发骨折、骨不连等情况.结论 改良双套管脉冲持续冲洗结合VSD法将可调控的脉冲冲洗技术与VSD技术相结合,能迅速控制炎症,有效促进骨髓炎清创术后的恢复.%Objective To analyze the clinically applied value of the continuous pulse flushing of the modified double tube and VSD in the treatment of osteomyelitis. Methods A retrospective analysis of 25 patients with osteomyelitis after fracture surgery was performed from January 2016 to January 2017. Fifteen patients were treated with continuous pulse flushing of the modified double tube and VSD for 7 days, and 10 cases were given traditional continuous flushing for 14 days after debridement. All patients completed a 6-month postoperative follow-up. Cure criteria depended on the efficacy evaluation indicators, including the level of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP), operation time, length of hospital stay, the number of dressing changes, local inflammation subsided time and the recurrence. Results As compared with the tradition group (50.4 ± 10.6) min, the operation time in modified group was 52.2 ± 8.7 min and there was no significant difference (P=0.646). The hospital stay (19.1 ± 2.8 days) was shorter, dressing changes (7.3 ± 1.5 times) less and local inflammation subsided time (24.9 ± 2.6 days) shorter in modified group than in tradition group (24.9 ± 4.7 days, 21.8 ± 4.5 times, and 30.8 ± 4.8 days) with the difference being significant between two groups (P<0.01 for all). The ESR and CRP levels in the modified group were significantly lower than those in the tradition group at 7th and 14th days (P<0.05 for both), and reached the normal levels 3 months later after surgery. Both groups of patients got primary healing and there were no recurrence cases. The fracture healing of the two groups was good, and there were no recurrent fractures or nonunion within 6 months after surgery. Conclusion The method of continuous pulse flushing of the modified double tube and VSD combines adjustable pulse irrigation technique with VSD technique. It can control the inflammation quickly and promote the recovery of osteomyelitis after debridement.