淋巴管内介入疗法预防下肢骨折术后感染的前瞻性研究

Endolymphatic intervention therapy for prevention of postoperative infection of the lower limb fracture： a prospective study

目的观察淋巴管内介入疗法预防下肢骨折术后感染的临床疗效。方法前瞻性研究接受手术治疗的严重下肢骨折住院患者160例。随机分为研究组和对照组，每组各80例。研究组采用淋巴管内介入疗法，对照组采用传统的抗生素静脉注射法。结果通过对淋巴小管收缩活性的评价证明，创伤和术后下肢大部分淋巴床的改变是功能性的、可逆的。研究组并发局部伤口感染5例（6．3％）、化脓性骨关节感染1例（1．3％），相应的对照组为16例（20．0％）和7例（8．8％）。研究组和对照组的住院时间分别为（15．6±0．6）d和（21．5±0．5）d。研究组使用头孢唑啉（5．0±0．54）g或林可霉素（1．5±0．14）g，而对照组使用相应抗生素（20．64±1．23）g或（6．19±0．15）g。结论淋巴管内介入疗法较传统的抗生素静脉注射疗法能更有效地预防下肢创伤及手术后感染。

Objective To observe the clinical therapeutic effect of endolymphatic intervention therapy on preventing the postoperative infection of the lower limb fracture. Methods A prospective study was conducted on 160 patients with severe lower limb fractures undergone surgical treatment. They were divided randomly into 2 equal groups： treatment group and control group. In treatment group, endolymphatic intervention therapy was adopted, while in control group, antibiotics was administered conventionally. Results It was proved by evaluating the contractile activity of the lymphoid canula that changes in most lymphoid beds of the lower limbs following fracture and operation were functional and reversible. Focal wound infection and suppurative infection of the bone and joint occurred in 5 cases （6.3%） and 1 （ 1.3% ） respectively in treatment group, and 16 （ 20. 0% ） and 7 （ 8.8% ） respectively in control group. The hospital stay was （15.6 ±0.6） days in treatment group and （21.5 ±0.5） days in control group. The total doses of cephazoline and cillimycin were （ 5.0 ± 0.54） g and （ 1.5 ± 0.14） g in treatment group, and （20.64 ± 1.23 ） g and （6.19 ± 0. 15 ） g in control group. Condusion Compared with conventional injection of antibiotics, endolymphatic intervention therapy is more effective in preventing of trauma and postoperative infection of the lower limb.