Ilizarov往复牵拉联合“牛鼻子”贯通引流治疗感染性胫骨不愈合的疗效研究

Research on efficacy of Ilizarov’s reciprocal retraction combined with"nose ring drain"in treatment of infectious tibial nonunion

目的研究伊里扎洛夫(Ilizarov)环形外固定架往复牵拉联合“牛鼻子”贯通引流治疗感染性胫骨不愈合的疗效。方法选取2015年1月—2021年1月新疆医科大学第六附属医院关节二科收治的41例感染性胫骨不愈合患者为研究对象,经过仔细彻底清创,胫骨断端使用Ilizarov环形外固定架与“牛鼻子”贯通引流处理,按照随机数字表法分为实验组及对照组,对照组使用标准Ilizarov牵拉技术联合“牛鼻子”贯通引流,实验组在对照组基础上采用往复牵拉技术治疗;比较患者术前一般资料、受伤的原因、骨缺损长度、骨愈合时间、外固定佩戴时间,外固定指数等;比较两组患者术前及拆除外固定架后膝关节(HSS)评分、踝关节(BJ)评分;同时比较两种治疗方案的安全性和有效性。结果与对照组比较,实验组患者骨愈合时间、外固定佩戴时间、外固定指数均减小,差异有统计学意义(P<0.05),ASAMI功能评分差异无统计学意义(P>0.05)。与本组术前比较,术后C反应蛋白计数、白细胞计数均降低,HSS评分、BJ评分均升高,差异有统计学意义(P<0.05)。结论往复牵拉技术结合“牛鼻子”贯通引流可缩短骨愈合时间、外固定佩戴时间、外固定指数,治疗感染胫骨不愈合的效果显著,可缩短胫骨不愈合患者康复周期。

Objective To study the efficacy of reciprocal retraction technique of Ilizarov′s circumferential external fixator combined with“nose ring drain”in treatment of infectious tibial nonunion.Methods From January 2015 to January 2021,41 patients with infectious tibial nonunion admitted to the hospital and were selected for the study.After careful and thorough debridement,the tibial break was treated with Ilizarov ring external fixator and“nose ring drain”.The control group was treated with standard Ilizarov retraction technique combined with“nose ring drain”,while the experimental group was treated with reciprocal retraction technique on the basis of the control group.The preoperative general information,cause of injury,length of bone defect,bone healing time,wearing time of external fixation,external fixation index,etc.were compared.HSS score of knee joint and BJ score of ankle joint before the surgery and after removal of the external fixation were compared between the two groups.The safety and efficacy of the two treatment regimens were compared.Results Compared with the control group,bone healing time,external fixation wearing time and external fixation index of the experimental group were decreased with statistical significance(P<0.05).There was no statistical significance in ASAMI function score(P>0.05).Compared with group before the operation,C-reactive protein count and white blood cell count were decreased,HSS score and BJ score were increased,and the difference was statistically significant(P<0.05).Conclusion The reciprocal pulling technique combined with“nose ring drain”can shorten bone healing time,external fixation wearing time and external fixation index,and it has a significant effect on treatment of infectious tibial nonunion and can shorten rehabilitation period of the patients with tibial nonunion.