模拟海水浸泡开放骨折的实验研究

Experimental study of open fractures with seawater immersion

目的观察海水浸泡开放骨折的伤口感染,组织学、影像学变化,了解海水浸泡开放骨折的伤情特点。方法新西兰大白兔75只,随机分为普通开放骨折组(对照组)27只和海水浸泡开放骨折组(实验组)48只。造成桡骨横行1．5mm缺损完全开放骨折,普通开放骨折伤组旷置3h,海水浸泡开放骨折伤组海水浸泡伤口3h,之后依次缝合伤口。于第1、3、7、14、21、28、45天处死动物。观察海水浸泡开放骨折伤在骨折愈合中不同时间的病理过程、影像学特点及伤口感染特点。结果(1)对照组肢体感染率11．9%,实验组肢体感染率31．0%(两组相比P＜0．05)。(2)海水浸泡开放骨折伤骨痂形成延迟,骨折后第28天,对照组断端间骨痂为骨性骨痂者8例,为软骨骨痂者4例；实验组断端间骨痂为骨性骨痂者6例,为软骨骨痂者14例。(3)骨折后第28天,断端间骨痂灰度值对照组为181．00±8．09,实验组为147．10±5．80；骨折后第45天,断端间骨痂灰度值对照组为217．50±7．50,实验组为243．00±8．26(两组相比P＜0．05)。结论(1)海水浸泡使开放骨折感染率增高；(2)海水浸泡使骨折愈合满意率下降,骨痂形成不良率增高,骨折愈合过程延迟。

Objective To study the wound infection, histopathology, and radiograph of open fractures after seawater immersion. Methods 75 New Zealand rabbits were divided into two group： 27 rabbits in group A, 48 rabbits in group B. Group A suffered with open fractures, and the wounded limbs were exposed in the air for three hours. Group B suffered with open fractures, and immersed in seawater for three hours. Both groups underwent debridement and suture. Rabbits were sacrificed 1, 3, 7, 14, 21, 28, 45 days after surgery, respectively, and wound infection, histopathology, and radiograph of open fractures were observed. Results （1） There was a significant difference in infection rate between group A, 11.9%, and group B,31.0% （ P 〈 0.05 ）. （2） On the 28th day, histopathological examination showed that there were 8 limbs with osteal callus, 4 limbs with chondral callus at the osteotomy site in group A; while there were 6 osteal callus and 14 chondral callus in group B. （3） On the 28th day, the grayscales of new bone callus were 181.00 ± 8.09 in group A and 147.10 ± 5.80 in group B （ P 〈 0.05 ） ; on the 45th day, the grayscales of new bone callus were 217.50± 7.50 in group A and 243.00 ± 8.26 in group B （ P 〈 0.05 ）. Conclusions （ 1 ） Seawater immersion increased wound infection rate of open fractures. （2） Seawater immersion also had obvious influence on fracture healing process, delaying bone repair and causing delayed union.