早期应用骨水泥治疗下肢Gustilo III型开放性骨折的临床疗效

Clinical Efficacy of Early Application of Bone Cement in the Treatment of Gustilo’s Type III Open Fractures of the Lower Extremity

摘要: 目的：探讨在下肢Gustilo III型开放性骨折的治疗中，早期应用骨水泥的临床疗效。方法：采用回顾性病例研究分析，收集2019年6月~2023年3月于重庆医科大学附属永川医院收治的14例患者的临床资料，所有患者均行分期手术治疗，采用骨水泥膜诱导技术治疗开放性骨折。通过采集术前术后的白细胞计数(white blood cell count, WBC)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、C-反应蛋白(C-reactive protein, CRP)指标；采集感染的症状体征情况，以及相应的影像学检查结果；用以评定是否发生感染，评估骨与软组织缺损愈合及并发症等情况，并基于Paley分类评估下肢功能；基于以上结果，分析患者的临床疗效。结果：II期术前的感染指标与I期相比，WBC、ESR、CRP较I期均有所下降，差异有统计学意义(P均 < 0.05)。所有患者伤口愈合均良好，未出现深部感染或皮肤坏死；无一例截肢。1例患者未行II期骨重建手术，余13例患者随访期内均达骨折临床愈合标准。所有患者均未发生慢性骨髓炎、下肢深静脉血栓、肺栓塞等并发症。下肢功能评定结果为优10例，良4例。结论：骨水泥膜诱导技术在下肢开放性骨折的早期应用，可有效预防感染，填充骨与软组织缺损部位，诱导膜可为后期植皮及更换内固定提供良好的生物学环境，有利于骨折与创面的良好愈合，临床疗效确切。

Abstract: Objective: To investigate the clinical efficacy of bone cement in the early application of Gustilo type III open fractures of the lower extremity. Methods: A retrospective case study was conducted to analyze the clinical data of 14 patients with open fractures treated with bone cement from June 2019 to June 2023 in Yongchuan Hospital of Chongqing Medical University. All patients underwent staged operation using the cement membrane induction technique for open fractures. The infection indicators were recorded. Infection indices were monitored, including white blood cell count (WBC), erythroeyte sedimentation rate (ESR) and C-reactive protein (CRP). Clearance of infection, signs and symptoms of infection, including pain, localized redness and swelling, warmth, oozing, odor, and sinus tract formation, that were inconsistent with the degree of injury, and corresponding imaging findings were recorded. The occurrence of infection, healing of bone and soft tissue defects, and complications were evaluated according to the hospital infection criteria; and the function of the lower extremities was assessed based on the Paley classification; based on the above results, the clinical efficacy of the patients was analyzed. Results: The indicators of infection in stage II compared with stage I. WBC, ESR, and CRP decreased compared with stage I, and the differences were statistically significant (P < 0.05). All patients had good wound healing without deep infection or skin necrosis; none of them had amputation. 1 patient did not undergo phase II bone reconstruction surgery, and the remaining 13 patients reached the clinical healing standard of fracture during the follow-up period. None of the patients had complications such as chronic osteomyelitis, lower extremity deep vein thrombosis, or pulmonary embolism. The results of lower limb function evaluation were excellent in 10 cases and good in 4 cases. Conclusion: The early application of bone cement membrane induction technique in open fractures of the lower limb can effectively prevent infection, fill the bone and soft tissue defects, and the induction membrane can provide a good biological environment for the later implantation and replacement of internal fixa-tion, which is conducive to the good healing of the fracture and trauma, and the clinical efficacy is exact.