硫酸镁湿敷联合头孢唑林钠静滴对足踝部骨折并发丹毒的疗效观察

Curative effect of magnesium sulfate wet compress combined with cefazolin sodium on foot and ankle fracture complicated with erysipelas

目的观察硫酸镁湿敷联合头孢唑林钠静滴对足踝部骨折患者术前并发下肢丹毒的临床疗效。方法回顾性分析2015年1月—2021年1月中国人民解放军中部战区总医院骨科收治的足踝部骨折并发下肢丹毒49例病例资料,其中男性32例,女性17例;年龄14~68岁,平均41.6岁;致伤原因运动损伤28例,高处坠落伤3例,暴力扭伤6例,道路交通伤12例。按治疗方式分为硫酸镁组(29例)与对照组(20例)。硫酸镁组采用硫酸镁湿敷联合头孢唑林钠静滴治疗,具体为将浸有50%硫酸镁的纱布持续湿敷于丹毒区域皮肤,湿敷的范围要略大于病变的范围,同时将注射用头孢唑林钠1g配入0.9%氯化钠注射液100mL静脉滴注,1次/8h,持续用药至术前1d;对照组仅使用头孢唑林钠静滴治疗。比较两组患者术前住院时间、总住院时间,治疗前后白细胞计数、中性粒细胞计数、C反应蛋白浓度,丹毒治疗效果,并对两种治疗方法进行卫生经济学评价。结果硫酸镁组术前住院时间及总住院时间均少于对照组(10.8±2.6)d vs.(12.5±1.7)d;(24.0±4.7)d vs.(27.1±4.3)d,P<0.05。两组患者治疗后白细胞计数、中性粒细胞计数及C反应蛋白浓度均有不同程度降低,其中白细胞计数及中性粒细胞计数差异有统计学意义(P<0.05)。参照孙凤兰丹毒疗效评分标准,硫酸镁组治疗6d后,痊愈6例,显效13例,好转7例,无效3例,治疗总有效率为65.5%;对照组治疗6d后总有效率为45.0%,硫酸镁组高于对照组(P<0.05)。硫酸镁组直接成本少于对照组(8132.9±1635.3)元vs.(8281.4±1415.5)元,P<0.05。结论硫酸镁湿敷联合头孢唑林钠静滴与单纯使用头孢唑林钠静滴均可治愈足踝部骨折并发丹毒,但前者疗效更满意,术前住院时间及总住院时间更短,卫生经济学评价具有更高的成本效益,值得临床推广。

Objective To observe the effect of magnesium sulfate wet compress combined with cefazolin sodium by intravenous drip on foot and ankle fractures complicated by erysipelas.Methods A retrospective analysis was conducted in the complete data of 49 cases of foot and ankle fractures complicated with erysipelas,who were admitted to Department of Orthopedics,General Hospital of the Central Theater Command of the Chinese People's Liberation Army from Jan.2015 to Jan.2021.There were 32 males and 17 females,aged 14-68 years,with an average of 41.6 years.The causes of injury included 28 cases of sports injuries,3 cases of falling from heights,6 cases of violent sprains,and 12 cases of road traffic injuries.According to the treatment method,they were divided into magnesium sulfate group(n=29)and control group(n=20).The magnesium sulfate group was treated with magnesium sulfate wet compress combined with intravenous drip of cefazolin sodium,specifically,50%magnesium sulfate gauze was continuously compressed on the skin of the erysipelas area,and the wet compress range was slightly larger than the range of the lesion.Meanwhile,1 g of 0.9%sodium chloride injection was mixed with 100 mL of intravenous drip,once every 8 hours,and continued to be used until 1 day before surgery.The control group was only treated with the above-mentioned intravenous drip of cefazolin sodium.The time from admission to operation,total hospital stay,white blood cell count,neutrophil count,C-reactive protein concentration,and erysipelas treatment effect before and after treatment were compared between the two groups.Evaluation of the health economics of the two treatments was also carried out.Results The time from admission to operation and the total hospital stay in the magnesium sulfate group were shorter than those in the control group[(10.8±2.6)days vs.(12.5±1.7)days;(24.0±4.7)days vs.(27.1±4.3)days,P<0.05].After treatment,the white blood cell count,neutrophil count and C-reactive protein concentration in the two groups were decreased to varying degrees,and the difference in white blood cell count and neutrophil count was statistically significant(P<0.05).Referring to Sun Fenglan erysipelas curative effect scoring standard,after 6 days of treatment in the magnesium sulfate group,6 cases were cured,13 cases were markedly effective,7 cases were improved,and 3 cases were ineffective,with a total effective rate of 65.5%.The effective rate was higher than that of the control group(P<0.05).The direct cost of magnesium sulfate group was less than that of control group[(8132.9±1635.3)yuan vs.(8281.4±1415.5)yuan,P<0.05].Conclusion Magnesium sulfate wet compress combined with intravenous infusion of cefazolin sodium and intravenous drip of cefazolin sodium alone can cure foot and ankle fractures complicated by erysipelas,but the former has more satisfactory curative effect,shorter preoperative hospital stay and total hospital stay,and higher cost-effectiveness,which is worthy of clinical promotion.