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

Clinical efficacy of bone transport and induced membrane technique with antibiotic-loaded cement in treatment of elderly patients with infectious nonunion after open fracture of tibia

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χ²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。

Abstract:

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.