超声波与冲击波联合负压封闭引流术对儿童血源性骨髓炎炎症的作用

Effect of ultrasound and shock wave combined with negative pressure closed drainage on inflammation of hematogenous osteomyelitis in children

目的探讨超声波与冲击波联合负压封闭引流术对儿童血源性骨髓炎炎症的作用。方法选取2016年9月至2019年10月郑州大学第一附属医院小儿外科收治的符合纳入标准的儿童血源性骨髓炎患者56例,根据采用的治疗方法分为对照组和观察组,每组28例,将采用单纯负压封闭引流术治疗的患者设为对照组,采用超声波与冲击波联合负压封闭引流术治疗的患者设为观察组。比较2组患者入院时与治疗1、2、3周后白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)的变化。计数资料用频数或率表示,其差异性比较采用χ^(2)检验或Fisher精确概率计算法(双侧)。结果入院时,对照组WBC、CRP、PCT、ESR分别为[(15.59±4.2)×10^(9)/L、(62.75±40.46)mg/L、(0.45±0.29)μg/L、(56.25±26.78)mm/h],观察组WBC、CRP、PCT、ESR分别为[(16.23±3.9)×10^(9)/L、(67.75±42.75)mg/L、(0.48±0.33)μg/L、(57.45±24.65)mm/h],两组患者WBC、CRP、PCT、ESR水平比较,差异均无统计学意义(t=0.591、0.449、0.361、0.174,P>0.05)。治疗2周后,对照组与观察组ESR分别为(37.13±11.59)、(30.56±10.53)mm/h,差异有统计学意义(t=2.220,P<0.05)。治疗3周后,对照组与观察组WBC分别为(6.38±2.10)×10^(9)/L、(5.37±1.35)×10^(9)/L,差异有统计学意义(t=2.141,P<0.05);CRP分别为(4.54±1.18)、(2.03±0.79)mg/L,差异有统计学意义(t=9.353,P<0.05);PCT分别为(0.07±0.04)、(0.05±0.03)μg/L,差异有统计学意义(t=2.117,P<0.05)。观察组总治愈率高于对照组(96.4%比82.1%,χ^(2)=2.987,P>0.05),差异无统计学意义。结论与单纯负压封闭引流术治疗儿童血源性骨髓炎比较,超声波与冲击波联合负压封闭引流术治疗儿童血源性骨髓炎炎症指标的降低更为显著。

Objective To investigate the effect of ultrasound and shock wave combined with negative pressure closed drainage on hematogenous osteomyelitis in children.Methods A total of Fifty-six children with hematogenous osteomyelitis who met the inclusion criteria in the Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2019 were divided into control group(n=28)and observation group(n=28).The patients treated with simple negative pressure closure drainage were divided into the control group and the observation group treated with ultrasound and shock wave combined with negative pressure closure drainage.The changes of white blood cells(WBC),C-reactive protein(CRP),procalcitonin(PCT)and erythrocyte sedimentation rate(ESR)were compared between the two groups at admission and after 1 week,2 weeks and 3 weeks of treatment.The measurement data were expressed as mean±standard deviation(±s),and the inflammation indexes were compared between groups by independent sample t-test.The counting data were expressed by frequency or rate,and the differences were compared by chi-square test or Fisher exact probability calculation method(both sides).Results On admission,the WBC,CRP,PCT and ESR of the control group were(15.59±4.2)×10^(9)/L,(62.75±40.46)mg/L,(0.45±0.29)μg/L,(56.25±26.78)mm/h respectively,while those in the observation group were(16.23±3.9)×10^(9)/L,(67.75±42.75)mg/L,(0.48±0.33)μg/L,(57.45±24.65)mm/h respectively,there was no significant difference in the levels of WBC,CRP,PCT and ESR between the two groups(t=0.591,0.449,0.361,0.174,P>0.05).After 2 weeks of treatment,the ESR in the control group and the observation group was(37.13±11.59)and(30.56±10.53)mm/h,and the difference was statistically significant(t=2.220,P<0.05).After 3 weeks of treatment,the WBC in the control group and the observation group were(6.38±2.10)×10^(9)/L and(5.37±1.35)×10^(9)/L respectively,and the difference was statistically significant(t=2.220,P<0.05);the CRP respectively were(4.54±1.18)and(2.03±0.79)mg/L,and there was significant difference between the two groups(t=9.353,P<0.05);the PCT respectively was(0.07±0.04)and(0.05±0.03)μg/L,and there was significant difference between the two groups(t=2.117,P<0.05).The total cure rate in the observation group was higher than that in the control group(96.4%vs.82.1%,χ^(2)=2.987,P>0.05).Conclusion Compared with simple negative pressure closed drainage in the treatment of children with hematogenous osteomyelitis,ultrasound and shock wave combined with negative pressure closed drainage can significantly reduce the inflammatory indexes in children with hematogenous osteomyelitis.