开窗与钻孔减压引流治疗儿童急性长骨骨髓炎的疗效分析

Clinical Analysis of Fenestration and Drilling Decompression in the Treatment of Acute Long Bone Osteomyelitis in Children

目的探讨开窗减压引流与钻孔减压引流两种方法治疗儿童急性长骨骨髓炎的疗效。方法选择2015年6月至2020年6月河北省儿童医院骨一科收治的急性长骨骨髓炎患儿267例为研究对象,并依据治疗方法不同将其分为开窗减压引流组132例,男65例,女67例;年龄2~16岁,平均年龄(6.45±3.78)岁;钻孔减压引流组135例,男69例,女66例;年龄2~17岁,平均年龄(7.24±3.46)岁;随访1年,依据Levin评分比较两组末次随访优良率;比较两组患儿临床指标包括体温恢复正常天数、拔管天数、术后住院天数、住院总费用、病理性骨折例数;比较两组患儿实验室指标包括术前、术后1、3、5、7 d的C反应蛋白(C-reactionprotein,CRP)、血沉(erythrocyte sedimentation rate,ESR)、降钙素原(procallcitonin,PCT)、白介素-6(Interleukin-6,IL-6)及淀粉样蛋白A(serum amyloid A,SAA)。结果末次随访开窗减压引流组优良率为93.18%(123例)、钻孔减压引流组优良率为92.59%(125例),两组差异无统计学意义(P=0.851);治疗期间开窗减压引流组13例发生病理性骨折,钻孔减压引流组11例发生病理性骨折,两组比较差异无统计学意义(P=0.627);体温恢复正常天数、拔管天数、术后住院天数、住院总费用比较显示开窗减压引流组低于钻孔减压引流组,差异有统计学意义(P<0.001);开窗减压引流组和钻孔减压引流组术前CRP、ESR、PCT、IL-6及SAA比较差异无统计学意义(P>0.05);术后第1、3、5、7d CRP、ESR、PCT、IL-6及SAA恢复情况比较显示,开窗减压引流组优于钻孔减压引流组,差异有统计学意义(P<0.001)。结论开窗减压引流和钻孔减压引流治疗儿童急性长骨骨髓炎最终优良率差异无统计学意义,但开窗减压引流术后各项炎症指标恢复情况明显优于钻孔减压引流,且开窗减压引流术后体温恢复正常时间、留置引流管天数缩短,降低了住院天数和住院总费用,其治疗儿童急性长骨骨髓炎明显优于钻孔减压引流,值得临床推广。

Objective To explore the effect of two methods of decompression drainage with fenestration and drilling in the treatment of acute long bone osteomyelitis in children.Methods A total of 267 children with acute long bone osteomyelitis were enrolled from June 2015 to June 2020 in the Department of Orthopaedics of Hebei Children's Hospital.According to the different treatment methods,132 patients were divided into fenestration decompression drainage group.There were 65 males and 67 females,with an average age of(6.45±3.78)years,ranging from 2 to 16 years.135 patients were divided into drilling decompression drainage group.There were 69 males and 66 females,with an average age of(7.24±3.46)years,ranging from 2 to 17 years.After 1 year follow-up,the excellent and good rates of the two groups were compared according to Levin Score.The clinical indexes of the two groups were compared,including the days of temperature return to normal,the days of extubation,the days of hospitalization,the total cost of hospitalization and the number of cases of pathological fracture.The laboratory indexes of the two groups included C-reaction protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin-6(IL-6)and serum amyloid A(SAA)before operation and 1、3、5、7 days after operation.Results At the last follow-up,93.18%(123 cases)of the drainage group and 92.59%(125 cases)of the drainage group had good results.No significant difference was found(P=0.851).13 cases of fenestration decompression group and 11 cases of drilling decompression group had pathological fracture.There was no significant difference between the two groups(P=0.627).However,the days of temperature recovery,extubation,hospitalization and total cost of hospitalization were significantly lower in fenestration decompression and drainage group than those in drilling decompression and Drainage Group(P<0.001).There was no significant difference in CRP,ESR,PCT,IL-6 and SAA between the two groups before operation(P>0.05).The recovery of CRP,ESR,PCT,IL-6 and SAA at 1,3,5,7 days after operation showed that fenestration decompression and drainage group was significantly better than drilling decompression g roup(P<0.001).Conclusion There is no difference in the final excellent and good rate between fenestration decompression drainage and drilling decompression drainage in the treatment of acute long bone osteomyelitis in children.However,the recovery of post-operative inflammatory parameters of patients with fenestration decompression and drainage is significantly better than that of patients with decompression and drainage by drilling.The time of temperature returning to normal,the days of indwelling drainage tube are shortened,the days of hospitalization and the total cost of hospitalization are reduced.The treatment of acute long bone osteomyelitis in children is obviously better than drilling decompression and drainage,which is worth popularizing in clinic.