VSD对骨折创面感染患者血清炎症因子及骨性标志物的影响

Effect of VSD treatment for open fracture of limbs occurred in patients with wound infection on inflammatory factor and serum bone markers

目的探讨负压封闭引流(vacuum sealing drainag,VSD)对四肢开放性骨折创面感染患者血清炎症因子及骨性标志物的影响,为四肢开放性骨折创面感染患者的临床诊治提供参考。方法选取2017年6月-2018年6月在河南省洛阳正骨医院内诊治的四肢开放性骨折创面感染患者100例,随机分为对照组与研究组,每组50例,对照组采用传统外科换药方法治疗,后期进行缝合或植皮治疗,研究组采用VSD方式治疗,观察患者创面换药次数、创面平均愈合时间、住院时间,治疗前及治疗7 d时超敏C-反应蛋白(hypersensitive c-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、白细胞介素-10(interleukin-10,IL-10)、血沉(erythrocyte sedimentation rate,ESR)、骨素钙(osteocalcin,BGP)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、总骨I型前胶原氨基端延长肽(total bone type I procollagen amino-terminal elongation peptide,tPINP)、I型前胶原羧基端肽(carboxyl terminal peptide,PICP)水平变化,评价治疗疗效。结果研究组患者创面换药次数、创面平均愈合时间、住院时间分别为(1.16±0.52)次、(16.21±5.49)d、(18.34±4.23)d,少于对照组的(8.57±5.37)次、(28.34±6.61)d、(32.67±7.55)d,差异均有统计学意义(P<0.05);两组患者治疗前hs-CRP、IL-6、IL-8、IL-10、ESR水平比较差异无统计学意义,治疗后各指标均较治疗前下降,且研究组低于对照组,差异均有统计学意义(P<0.05);研究组患者治疗疗效优于对照组患者,差异有统计学意义(Z=2.894,P=0.004)。结论VSD治疗四肢开放性骨折创面感染有助于缩短治疗疗程及提高疗效,促进炎症吸收,但对骨性标志物无明显影响。

OBJECTIVE To explore the variation of inflammatory factors and serum bone markers after the treatment of Vacuum Sealing Drainag(VSD)for open fracture of limbs occurred in patients with wound infection,so as to provide reference for the clinical diagnosis and treatment.METHODS We selected 100 cases of open fracture of limbs patients with wound infection in Henan Luoyang Orthopaedic Hospital from June 2017 to June 2018.They were randomly divided into the control group and the research group,50 cases in each group.The control group was treated with traditional surgical dressing change,followed by suture or skin grafting in the successive treatment and the research group was treated with VSD.Wound dressing change times,average wound healing time,hospitalization time were recorded.And the concentration of hypersensitive c-reactive protein(hs-CRP),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),erythrocyte sedimentation rate(ESR),osteocalcin(BGP),bone alkaline phosphatase(BALP),total bone type I procollagen amino-terminal elongation peptide(tPINP)and carboxyl terminal peptide(PICP)before and 7 days after the treatment of both groups were compared to evaluate therapeutic effects.RESULTS Wound dressing change times were(1.16±0.52)times,average wound healing time was(16.21±5.49)d and hospitalization time was(18.34±4.23)d in the research group,with(8.57±5.37)times,(28.34±6.61)d and(32.67±7.55)d in the control group.The difference between them was significant(P<0.05).There was no significant difference between the levels of hs-CRP,IL-6,IL-8,IL-10 and ESR in the research group and the control group,although they were all lower after the treatment than before(P<0.05).And the indexes in the research group were significantly lower than in the control group after the treatmen t(Z=2.894,P=0.004).CONCLUSION VSD treatment of open fracture of limbs occurred in patients with wound infection can be helpful to shorten the treatment course,improve the curative effect and promote inflammatory absorption,but had no obvious effect on bone markers.