早期抗生素骨水泥处理Gustilo-III型胫骨骨折创面的临床疗效

Clinical Efficacy of Early Antibiotic Bone Cement in the Management of Gustilo-III Tibial Fracture Wounds

摘要: 目的：探索早期应用抗生素骨水泥处理Gustilo-III型胫骨骨折创面的临床疗效。方法：回顾性分析2017年1月~2021年1月本院骨科收治的56例Gustilo-III型胫骨骨折患者的临床资料，26例患者行抗生素骨水泥治疗，30例患者行常规换药治疗，比较两种方式处理骨折创面的临床效果。结果：两组患者均顺利完成手术，ALBC组二期术前换药次数、间隔时间，术后VAS疼痛评分、创面愈合情况及住院时间均显著优于常规组(P < 0.05)。血液检验方面，一期术前两组血液检测指标差异无统计学意义(P > 0.05)，与一期术前相比，二期术前、出院时两组患者WBC和CRP均显著下降(P < 0.05)，ALBC组的上述指标均显著优于常规组(P < 0.05)。并发症方面，ALBC组并发症发生率显著低于常规组(P < 0.05)。结论：早期应用抗生素骨水泥处理Gustilo-III型胫骨骨折患者创面，能够有效预防术后感染，促进软组织重建，临床疗效显著。

Abstract: Objective: This study aimed to investigate the clinical effect of early application of antibiotic bone cement in the treatment of Gustilo type III tibia fracture. Methods: A retrospective study was con-ducted on a total of 56 patients who received surgical treatment for Gustilo type III tibia fracture in our hospital from January 2017 to January 2021. Among them, 26 patients were treated with Anti-biotic-loaded bone cement (ALBC), and 30 patients were treated with conventional dressing change (DC) temporally after debridement and external fixation. The clinical and laboratory results were compared between the two groups. Results: The operations were successfully completed in both groups. The ABLC group was significantly better than conventional group in term of the times of dressing change before second stage surgery, interval for second stage surgery, postoperative VAS scores, wound healing time and hospital stay and incidence of complications (P < 0.05). In terms of blood tests, WBC and CRP were significantly decreased in both groups at the discharge compared with those before primary operation (P < 0.05). Although there were no statistically significant dif-ferences in the blood test items between the two groups before the first operation (P > 0.05), the ABLC group was significantly better than the conventional group in abovementioned items at dis-charge (P < 0.05). In terms of complications, the incidence of soft tissue infection and osteomyelitis in the ALBC group was significantly better than that in the conventional group (P < 0.05). Conclu-sion: The treatment method of early application of antibiotic bone cement in patients with Gustilo type III tibial fracture can effectively cover the wound surface to prevent postoperative infection and promote soft tissue reconstruction, and the clinical treatment effect is remarkable.