电动脉冲冲洗技术在胫骨慢性Ⅲ型局限性骨髓炎中的应用效果

Application of pulse flushing technology in the treatment of tibial chronic typeⅢlimited myelitis

目的探讨电动脉冲冲洗技术在胫骨慢性Ⅲ型局限性骨髓炎中的应用效果。方法回顾性分析2015年1月至2018年5月华中科技大学同济医学院附属协和医院收治的70例胫骨慢性Ⅲ型局限性骨髓炎患者,采用随机数字表法分为两组,每组35例,其中观察组术中应用电动脉冲冲洗技术,而对照组术中采用常规传统倾倒法进行冲洗。两组冲洗前后在创面各取0.5ml渗出物行细菌涂片、细菌培养,术后2d和7d取伤口周围渗液进行细菌培养。比较两组冲洗伤口用时、冲洗液体用量、术后3周伤口愈合情况。结果冲洗前两组所有患者细菌涂片及细菌培养结果均为阳性。观察组冲洗后细菌涂片阴性率为100%,明显高于对照组的88.6%,差异有显著性(P=0.04),而两组冲洗后的细菌培养阴性率(分别为91.4%、82.9%)、术后2d的细菌培养阴性率(分别为88.6%、77.1%)、术后7d的细菌培养阴性率(分别为77.1%、71.4%)比较差异均无显著性(P>0.05)。观察组冲洗伤口用时为(540.7±10.6)s,明显低于对照组的(752.2±17.6)s,冲洗液体用量为(3213.1±145.0)ml,明显低于对照组的(3634.6±174.6)ml,差异均有显著性(P<0.05)。术后3周观察组伤口甲级愈合3例、乙级愈合21例、丙级愈合11例,对照组甲级愈合2例、乙级愈合18例、丙级愈合15例,两组比较差异无显著性(P>0.05)。结论电动脉冲冲洗技术在胫骨慢性Ⅲ型局限性骨髓炎清创术中的应用效果良好,可明显缩短冲洗时间,减少冲洗液的用量。

Objective To analyze the application effect of electric pulse flushing technology in the chronic type Ⅲ limited myelitis of the tibia. Method 70 patients with chronic tibia type Ⅲ myelitis admitted to our hospital from January 2015 to May 2018 were retrospectively analyzed of whom 35 patients were treated with pulse flushing technique in surgery(experimental group), and 35 patients were flushed by conventional traditional dumping method(control group) during the operation. The two groups were compared before and after the flushing each take 0.5 ml of permeable to do bacterial culture and colony count, 2 days and 7 days after surgery wound around the seepage to do bacterial culture and colony count, flushing wound time, flushing the wound consumed liquid amount, after 3 week of wound B-level healing. Result The bacterial smear and culture results of the two groups were 100% positive before washing. The negative rate of bacterial smear after pulse rinsing was 100%, while the negative rate of bacterial smear after dumping rinsing was 88.6%.After pulse flushing the bacteria culture negative is 91.4%, dumping method flushing the bacteria culture negative is 82.9%, 2 days after surgery the bacteria culture negative is 88.6%, dumping method flushing the negative is 77.1%,7 days after surgery the bacteria culture negative is 77.1%, dumping method flushing the negative is 71.4% pulse flushing takes an average of(540.7±10.6) s, dumping method takes an average of(752.2±17.6) s, pulse rafter requires a liquid amount of(3213.1±145.0) ml, dumping method(3634.6±174.6) ml, 3 week after pulse flushing wound A-level healing 8.6%, B-level healing 60%, C-level healing31.4%, dumping method A-level healing 5.7%, Class B healing 51.4%, C-level healing 42.9%. Conclusion The application of electric pulse irrigation technique in debridement of chronic type Ⅲ limited osteomyelitis of tibia is satisfactory, which significantly reduces the time of surgical cleaning, reduces the use of flushing fluid.