骨搬运和抗生素骨水泥结合膜诱导技术治疗老年胫骨开放骨折后感染性骨不连患者的疗效
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摘要
目的对比骨搬运和抗生素骨水泥结合膜诱导技术治疗胫骨开放性骨折后感染性骨不连老年患者的临床疗效。方法回顾性分析2013年5月至2016年5月解放军总医院海南医院和解放军总医院第一临床医学中心骨科收治的胫骨开放性骨折后感染性骨不连老年患者72例,研究组和对照组各36例,研究组患者给予骨搬运技术治疗,对照组患者给予抗生素骨水泥结合膜诱导技术治疗。随访12个月,对比2组患者的对位对线情况、骨愈合指数、美国膝关节协会(AKS)膝关节功能评分、Baird-Jackson踝关节功能评分和临床疗效。应用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果 2组患者的年龄、性别及骨折位置等差异无统计学意义(P>0.05)。研究组相比于对照组,手术时间缩短[(135±17) vs(146±12)min],AKS膝关节功能评分[(165.7±15.2) vs (123.7±18.1)]和Baird-Jackson踝关节功能评分[(88.6±3.6) vs(77.6±5.4)]提高,骨愈合指数[(42.0±2.0) vs (43.3±3.0)d/cm]降低,临床有效率高[61.1%(22/36) vs 47.2%(17/36)],感染发生率低[5.6%(2/36) vs 25.0%(9/36)],差异均具有统计学意义(P<0.05)。结论骨搬运技术能够促进胫骨开放性骨折后感染性骨不连老年患者的功能康复,值得临床推广。
Objective To compare the clinical efficacy of bone transport with antibiotic bone cement combined with membrane induction in the treatment of infectious nonunion after open tibial fracture in the elderly.Methods A retrospective study was performed on 72 elderly patients with infectious nonunion after open tibial fractures who admitted to our 2 Orthopedic Departments from May 2013 to May 2016.According to the treatment,they were assigned into study group( n = 36,bone transport) and control group(n = 36,antibiotic bone cement combined with membrane induction).All the patients were followed up for 12 months.The contralateral alignment,bone healing index,American Knee Society( AKS) score for knee function,Baird-Jackson score of ankle function and clinical outcomes were compared between the 2 groups.The data were analyzed by SPSS statistics 19.0 software.Chi-square test or Student's t test was used for the comparison between the 2 groups.Results There was no significant differences in age,sex and fracture location between the 2 groups( P>0.05).The study group had significantly shorter operation time [(135±17) vs(146±12) min],higher AKS score [(165.7±15.2) vs(123.7±18.1)] and Baird-Jackson score [( 88.6 ± 3.6) vs( 77.6 ± 5.4)] and lower bone healing index[(42.0±2.0) vs(43.3±3.0)d/cm],better clinical efficacy [61.1%(22/36) vs 47.2%(17/36)],and lower incidence of infection [5.6%(2/36) vs 25.0%(9/36)]when compared with the control group( all P<0.05).Conclusion Bone transport technique can promote the functional recovery in the elderly patients with infectious nonunion after open tibial fracture,and it is worthy of clinical promotion.
Objective To compare the clinical efficacy of bone transport with antibiotic bone cement combined with membrane induction in the treatment of infectious nonunion after open tibial fracture in the elderly.Methods A retrospective study was performed on 72 elderly patients with infectious nonunion after open tibial fractures who admitted to our 2 Orthopedic Departments from May 2013 to May 2016.According to the treatment,they were assigned into study group( n = 36,bone transport) and control group(n = 36,antibiotic bone cement combined with membrane induction).All the patients were followed up for 12 months.The contralateral alignment,bone healing index,American Knee Society( AKS) score for knee function,Baird-Jackson score of ankle function and clinical outcomes were compared between the 2 groups.The data were analyzed by SPSS statistics 19.0 software.Chi-square test or Student's t test was used for the comparison between the 2 groups.Results There was no significant differences in age,sex and fracture location between the 2 groups( P>0.05).The study group had significantly shorter operation time [(135±17) vs(146±12) min],higher AKS score [(165.7±15.2) vs(123.7±18.1)] and Baird-Jackson score [( 88.6 ± 3.6) vs( 77.6 ± 5.4)] and lower bone healing index[(42.0±2.0) vs(43.3±3.0)d/cm],better clinical efficacy [61.1%(22/36) vs 47.2%(17/36)],and lower incidence of infection [5.6%(2/36) vs 25.0%(9/36)]when compared with the control group( all P<0.05).Conclusion Bone transport technique can promote the functional recovery in the elderly patients with infectious nonunion after open tibial fracture,and it is worthy of clinical promotion.
引文
[1]宋扬,程维.骨搬运技术治疗骨不连后大段骨缺损的临床研究[J].北华大学学报(自然科学版),2016,17(6):808-811.DOI:10.11713/j.issn.1009-4822.2016.06.024.Song Y,Cheng W.Clinical research on Ilizarov technology in the treatment of large segment bone defect after bone nonunion[J].JBeihua Univ(Nat Sci),2016,17(6):808-811.DOI:10.11713/j.issn.1009-4822.2016.06.024.
[2]张恒林,谢文凯,羊才丰,等.老年创伤骨折患者伤情特点及血栓形成的危险因素[J].中华老年多器官疾病杂志,2017,16(9):677-681.DOI:10.11915/j.issn.1671-5403.2017.09.159.Zhang HL,Xie WK,Yang CF,et al.Injury characteristics and risk factors of thrombosis in elderly patients with traumatic fracture[J].Chin J Mult Organ Dis Elderly,2017,16(9):677-681.DOI:10.11915/j.issn.1671-5403.2017.09.159.
[3]房辉强,万富贵,欧阳王斌.骨搬运技术治疗胫骨慢性骨髓炎临床观察[J].深圳中西医结合杂志,2016,26(15):92-94.DOI:10.1 64 58/j.cnik.1007-0893.2016.15.048.Fang HQ,Wan FG,Ouyang WB.Clinical observation on effect of Ilizarov bone transport technology in treating chronic osteomyelitis of tibia[J].Shenzhen J Integr Trad Chin West Med,2016,26(15):92-94.DOI:10.1 64 58/j.cnik.1007-0893.2016.15.048.
[4]代元元,章莹,夏远军,等.应用单臂外固定支架治疗胫骨慢性复发性骨髓炎[J].实用骨科杂志,2015,21(10):939-941.DOI:10.13795/j.cnki.sgkz.2015.10.022.Dai YY,Zhang Y,Xia YJ,et al.Application of single arm external fixation in treating chronic recurrent osteomyelitis of tibia[J].JPract Orthop,2015,21(10):939-941.DOI:10.13795/j.cnki.sgkz.2015.10.022.
[5]袁冰,韦卓.骨缺损修复的研究进展[J].生物骨科材料与临床研究,2014,11(3):38-41.DOI:10.3969/j.issn.1672-5972.2014.03.010.Yuan B,Wei Z.Research progress of bone defect repair[J].Orthop Biomech Mater Clin Study,2014,11(3):38-41.DOI:10.3969/j.issn.1672-5972.2014.03.010.
[6]Maempel JF,Clement ND,Brenkel IJ,et al.Validation of a prediction model that allows direct comparison of the Oxford Knee Score and American Knee Society clinical rating system[J].Bone Joint J,2015,97-B(4):503-509.DOI:10.1302/0301-620X.97B4.34867.
[7]Xing W,Xie P,Wang L,et al.The application of intraoperative ankle dislocation approach in the treatment of the unstable trimalleolar fractures involving posterior ankle comminuted fracture:a retrospective cohort study[J].BMC Surg,2018,18(1):23.DOI:10.1186/s12893-018-0356-9.
[8]陈东旭,薄占东.骨髓炎的治疗现状及进展[J].中国矫形外科杂志,2012,20(3):224-227.Chen DX,Bo ZD.Treatment status and progress of osteomyelitis[J].Orthop J China,2012,20(3):224-227.
[9]王景双,胡思斌,马杰,等.Ilizarov技术改善骨搬运中轴向偏移的临床研究[J].中国修复重建外科杂志,2016,30(5):546-550.DOI:10.7507/1002-1892.20160110.Wang JS,Hu SB,Ma J,et al.Clinical observation of improving axial offset by using Ilizarov bone transport technology[J].Chin JRepar Reconstr Surg,2016,30(5):546-550.DOI:10.7507/1002-1892.20160110.
[10]杨华清,王坤正,张明宇,等.应力调节对延长区骨愈合影响的实验研究[J].中国矫形外科杂志,2008,16(18):1412-1414.Yang HQ,Wang KZ,Zhang MY,et al.Influence of stress regulation on bone healing of lengthened zone:an experimental study[J].Orthop J China,2008,16(18):1412-1414.
[11]崔光秀,邵忠,张英军,等.Ilizarov技术在胫骨骨缺损性骨不连中的临床应用[J].中国现代药物应用,2015,9(6):73-74.DOI:10.14164/j.cnki.cn11-5581/r.2015.06.055.Cui GX,Shao Z,Zhang YJ,et al.Clinical application of Ilizarov technique in treating tibia defect nonunion[J].Chin J Mod Drug Appl,2015,9(6):73-74.DOI:10.14164/j.cnki.cn11-5581/r.2015.06.055.
[12]韩庆海,张庆彬,赵殿钊,等.双段截骨斜拉针骨延长与加压治疗胫骨大段感染性骨缺损[J].中华创伤骨科杂志,2015,17(10):858-862.DOI:10.3760/cma.j.issn.1671-7600.2015.10.007.Han QH,Zhang QB,Zhao DZ,et al.Residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomy to treat massive infectious defect of the tibia[J].Chin JOrthop Trauma,2015,17(10):858-862.DOI:10.3760/cma.j.issn.1671-7600.2015.10.007.
[13]龙超,刘炳胜,王玮.环形外固定架骨搬运治疗胫骨创伤后大段骨缺损[J].中国骨伤,2013,26(4):281-283.DOI:10.3969/j.issn.1003-0034.2013.04.005.Long C,Liu BS,Wang W.Transosseous osteosynthesis with annular external fixator for the treatment of long bone defect after tibial trauma[J].Chin J Orthop Trauma,2013,26(4):281-283.DOI:10.3969/j.issn.1003-0034.2013.04.005.
[14]王军,魏华,张永飞,等.骨搬运技术治疗胫骨骨缺损疗效及影响因素分析[J].中国骨与关节损伤杂志,2016,31(2):164-167.DOI:10.7531/j.issn.1672-9935.2016.02.016.Wang J,Wei H,Zhang YF,et al.Effects of bone transport in treatment of tibial bone defect and its influencing factor[J].Chin JBone Jt Inj,2016,31(2):164-167.DOI:10.7531/j.issn.1672-9935.2016.02.016.
[15]陈伟,齐新文,张英明,等.Ilizarov技术骨搬移治疗胫骨骨不连并软组织缺损感染[J].西部医学,2014,26(8):993-995.DOI:10.3969/j.issn.1672-3511.2014.08.011.Chen W,Qi XW,Zhang YM,et al.Ilizarov technique bone transportion to treat tibial nonunion and soft tissue defect infection[J].Med J West China,2014,26(8):993-995.DOI:10.3969/j.issn.1672-3511.2014.08.011.
[2]张恒林,谢文凯,羊才丰,等.老年创伤骨折患者伤情特点及血栓形成的危险因素[J].中华老年多器官疾病杂志,2017,16(9):677-681.DOI:10.11915/j.issn.1671-5403.2017.09.159.Zhang HL,Xie WK,Yang CF,et al.Injury characteristics and risk factors of thrombosis in elderly patients with traumatic fracture[J].Chin J Mult Organ Dis Elderly,2017,16(9):677-681.DOI:10.11915/j.issn.1671-5403.2017.09.159.
[3]房辉强,万富贵,欧阳王斌.骨搬运技术治疗胫骨慢性骨髓炎临床观察[J].深圳中西医结合杂志,2016,26(15):92-94.DOI:10.1 64 58/j.cnik.1007-0893.2016.15.048.Fang HQ,Wan FG,Ouyang WB.Clinical observation on effect of Ilizarov bone transport technology in treating chronic osteomyelitis of tibia[J].Shenzhen J Integr Trad Chin West Med,2016,26(15):92-94.DOI:10.1 64 58/j.cnik.1007-0893.2016.15.048.
[4]代元元,章莹,夏远军,等.应用单臂外固定支架治疗胫骨慢性复发性骨髓炎[J].实用骨科杂志,2015,21(10):939-941.DOI:10.13795/j.cnki.sgkz.2015.10.022.Dai YY,Zhang Y,Xia YJ,et al.Application of single arm external fixation in treating chronic recurrent osteomyelitis of tibia[J].JPract Orthop,2015,21(10):939-941.DOI:10.13795/j.cnki.sgkz.2015.10.022.
[5]袁冰,韦卓.骨缺损修复的研究进展[J].生物骨科材料与临床研究,2014,11(3):38-41.DOI:10.3969/j.issn.1672-5972.2014.03.010.Yuan B,Wei Z.Research progress of bone defect repair[J].Orthop Biomech Mater Clin Study,2014,11(3):38-41.DOI:10.3969/j.issn.1672-5972.2014.03.010.
[6]Maempel JF,Clement ND,Brenkel IJ,et al.Validation of a prediction model that allows direct comparison of the Oxford Knee Score and American Knee Society clinical rating system[J].Bone Joint J,2015,97-B(4):503-509.DOI:10.1302/0301-620X.97B4.34867.
[7]Xing W,Xie P,Wang L,et al.The application of intraoperative ankle dislocation approach in the treatment of the unstable trimalleolar fractures involving posterior ankle comminuted fracture:a retrospective cohort study[J].BMC Surg,2018,18(1):23.DOI:10.1186/s12893-018-0356-9.
[8]陈东旭,薄占东.骨髓炎的治疗现状及进展[J].中国矫形外科杂志,2012,20(3):224-227.Chen DX,Bo ZD.Treatment status and progress of osteomyelitis[J].Orthop J China,2012,20(3):224-227.
[9]王景双,胡思斌,马杰,等.Ilizarov技术改善骨搬运中轴向偏移的临床研究[J].中国修复重建外科杂志,2016,30(5):546-550.DOI:10.7507/1002-1892.20160110.Wang JS,Hu SB,Ma J,et al.Clinical observation of improving axial offset by using Ilizarov bone transport technology[J].Chin JRepar Reconstr Surg,2016,30(5):546-550.DOI:10.7507/1002-1892.20160110.
[10]杨华清,王坤正,张明宇,等.应力调节对延长区骨愈合影响的实验研究[J].中国矫形外科杂志,2008,16(18):1412-1414.Yang HQ,Wang KZ,Zhang MY,et al.Influence of stress regulation on bone healing of lengthened zone:an experimental study[J].Orthop J China,2008,16(18):1412-1414.
[11]崔光秀,邵忠,张英军,等.Ilizarov技术在胫骨骨缺损性骨不连中的临床应用[J].中国现代药物应用,2015,9(6):73-74.DOI:10.14164/j.cnki.cn11-5581/r.2015.06.055.Cui GX,Shao Z,Zhang YJ,et al.Clinical application of Ilizarov technique in treating tibia defect nonunion[J].Chin J Mod Drug Appl,2015,9(6):73-74.DOI:10.14164/j.cnki.cn11-5581/r.2015.06.055.
[12]韩庆海,张庆彬,赵殿钊,等.双段截骨斜拉针骨延长与加压治疗胫骨大段感染性骨缺损[J].中华创伤骨科杂志,2015,17(10):858-862.DOI:10.3760/cma.j.issn.1671-7600.2015.10.007.Han QH,Zhang QB,Zhao DZ,et al.Residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomy to treat massive infectious defect of the tibia[J].Chin JOrthop Trauma,2015,17(10):858-862.DOI:10.3760/cma.j.issn.1671-7600.2015.10.007.
[13]龙超,刘炳胜,王玮.环形外固定架骨搬运治疗胫骨创伤后大段骨缺损[J].中国骨伤,2013,26(4):281-283.DOI:10.3969/j.issn.1003-0034.2013.04.005.Long C,Liu BS,Wang W.Transosseous osteosynthesis with annular external fixator for the treatment of long bone defect after tibial trauma[J].Chin J Orthop Trauma,2013,26(4):281-283.DOI:10.3969/j.issn.1003-0034.2013.04.005.
[14]王军,魏华,张永飞,等.骨搬运技术治疗胫骨骨缺损疗效及影响因素分析[J].中国骨与关节损伤杂志,2016,31(2):164-167.DOI:10.7531/j.issn.1672-9935.2016.02.016.Wang J,Wei H,Zhang YF,et al.Effects of bone transport in treatment of tibial bone defect and its influencing factor[J].Chin JBone Jt Inj,2016,31(2):164-167.DOI:10.7531/j.issn.1672-9935.2016.02.016.
[15]陈伟,齐新文,张英明,等.Ilizarov技术骨搬移治疗胫骨骨不连并软组织缺损感染[J].西部医学,2014,26(8):993-995.DOI:10.3969/j.issn.1672-3511.2014.08.011.Chen W,Qi XW,Zhang YM,et al.Ilizarov technique bone transportion to treat tibial nonunion and soft tissue defect infection[J].Med J West China,2014,26(8):993-995.DOI:10.3969/j.issn.1672-3511.2014.08.011.
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