两种不同方法联合负压封闭引流技术对胫腓骨开放性骨折合并软组织缺损患儿踝关节功能的影响

Effects of two different methods combined with vacuum sealing drainage on ankle function in children with tibiofibular open fracture and soft tissue defects

目的探讨两种不同方法联合负压封闭引流技术对胫腓骨开放性骨折合并软组织缺损患儿的治疗效果。方法纳入2017年4月至2019年4月浙江中医药大学附属江南医院收治的胫腓骨开放性骨折合并软组织缺损患儿(年龄≤14岁)84例,采用随机数字表法分为对照组(44例)和观察组(40例)。对照组患儿采用Ilizarov环形外固定架联合负压封闭引流技术治疗,观察组患儿采用盐酸头孢甲肟与Ilizarov环形外固定架联合负压封闭引流技术治疗。比较治疗前和治疗后6个月两组患儿的炎症因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin 6,IL-6)、C反应蛋白(C-reactive protein,CRP)]水平、疼痛视觉模拟量表(Visual analogue scale,VAS)评分、踝关节功能及治疗后6个月时的创面愈合率。结果治疗前两组患儿的血清TNF-α、IL-6、CRP水平比较差异无显著性(P>0.05),治疗后两组血清TNF-α、IL-6、CRP水平均明显低于治疗前,且观察组明显低于对照组,差异有显著性(P<0.05)。治疗前两组VAS评分比较差异无显著性(P>0.05),治疗后两组VAS评分均明显低于治疗前,且观察明显低于对照组,差异有显著性(P<0.05)。治疗前两组踝关节疼痛、活动度、功能及步态评分比较差异无显著性(P>0.05),治疗后两组踝关节疼痛、活动度、功能及步态评分均明显高于治疗前,且观察组明显高于对照组,差异有显著性(P<0.05)。治疗后6个月时观察组创面愈合率(94.5%±8.79%)明显高于对照组(81.8%±7.42%),差异有显著性(P<0.05)。结论对于儿童胫腓骨开放性骨折合并软组织缺损采用盐酸头孢甲肟与Ilizarov环形外固定架联合负压封闭引流治疗可降低炎症因子表达水平,缓解疼痛,增强踝关节功能,提高创面愈合质量,值得临床应用。

Objective To investigate the effect of cefoxime hydrochloride and Ilizarov ring external fixator combined with negative pressure sealing drainage in the treatment of open tibiofibular fractures combined with soft tissue defects in children.Method From April 2017 to April 2019,84 children(age≤14 years)with open tibia and fibula fractures combined with soft tissue defects admitted to Jiangnan Hospital Affiliated to Zhejiang University of Chinese Medicine were enrolled and divided into control group(44 cases)and observation group(40 cases)by random number table method.Children in the control group were treated with Ilizarov ring external fixator combined with negative pressure sealing drainage technology,while children in the observation group were treated with cefoxime hydrochloride and Ilizarov ring external fixator combined with negative pressure sealing drainage technology.Tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(C-reactive protein)were compared between the two groups before treatment and 6 months after treatment.CRP level,VAS score,ankle function and wound healing rate.Result Before treatment,the serum levels of TNF-α,IL-6 and CRP in the two groups had no significant difference(P>0.05),after treatment,the serum levels of TNF-α,IL-6 and CRP in the two groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,the difference was significant(P<0.05).There was no significant difference in VAS score between the two groups before treatment(P>0.05).After treatment,the VAS score of the two groups was significantly lower than that before treatment,and the observation was significantly lower than that of the control group,and the difference was significant(P<0.05).Before treatment,there was no significant difference in ankle pain,range of motion,function and gait scores between the two groups(P>0.05).After treatment,the ankle pain,range of motion,function and gait scores of the two groups were significantly higher than those before treatment,and the observation group was significantly higher than the control group,and the difference was significant(P<0.05).There was no significant difference in the wound healing rate between the two groups before treatment(P>0.05),but the wound healing rate of the two groups after treatment was significantly higher than that before treatment,and the observation group was significantly higher than the control group,and the difference was significant(P<0.05).Conclusion For children with open tibia and fibula fractures complicated with soft tissue defects,cefoxime hydrochloride and Ilizarov ring external fixator combined with negative pressure sealing drainage can reduce the expression level of inflammatory factors,relieve pain,enhance ankle joint function,and improve the quality of wound healing,which is worthy of clinical application.