复方蜈蚣颗粒结合外固定骨搬移技术治疗开放性胫骨骨折术后感染的疗效观察

Observation of Curative Efficacy of Compound Centipedes Granule Combined with Ilizarov Technique in Treating Postoperative Infection of Open Tibial Fracture

目的:探讨运用复方蜈蚣颗粒结合Ilizarov技术治疗开放性胫骨骨折术后感染的临床疗效及安全性。方法:采用回顾性病例系列研究分析2017年2月至2021年1月收治的37例开放性胫骨骨折术后感染患者的病例资料,所有患者均采用感染骨段切除、Ilizarov技术治疗,必要时采用负压引流术及皮瓣转移修复创面,术后口服中成药复方蜈蚣颗粒。根据末次随访Paley感染性骨缺损骨愈合评分标准和邻近关节功能评定进行临床疗效评价。结果:37例患者均获随访,随访时间为14~36个月,平均为18.6个月,所有伤口及骨折均愈合,感染未复发;术后1个月白细胞计数(WBC)、C反应蛋白(CRP)及红细胞沉降率(ESR)指标较术前均明显降低,差异有统计学意义(P<0.05);伤口愈合时间为14~32 d,平均为18 d;骨愈合时间为6.3~13.8个月,平均为10.2月。末次随访根据Paley感染性骨缺损骨愈合评分标准评价结果:优14例,良18例,优良率为86.5%。邻近关节功能评定结果:优11例,良19例,优良率为81.1%。结论:复方蜈蚣颗粒结合Ilizarov技术治疗开放性胫骨骨折术后感染疗效安全可靠,有助于肢体功能的恢复,值得临床推广应用。

Objective:To investigate the clinical efficacy and safety of compound centipedes granule combined with Ilizarov technique on the treatment of postoperative infection of open tibial fracture.Methods:A retrospective case-series study was conducted to analyze the clinical data of 37 patients with postoperative infection of open tibial fractures from February 2017 to January 2021.All patients were treated by resection of infected bone segment and Ilizarov technique,and if necessary,negative pressure drainage and skin flap transfer were used to repair the wound.Traditional Chinese medicine compound centipede granules was taken orally after operation.The healing of infected bone defects and the assessment of adjacent joint function were used to evaluated clinical efficacy according to the Paley’s scoring system.Results:All the 37 patients were followed up for 14 to 36 months with 18.6 months on average.Wounds and fractures were healed without recurrence of infection.White blood cell(WBC),C-reaction protein(CRP)and erythrocyte sedimentation rate(ESR)were significantly lower 1 month after operation than those before operation(P<0.05).The healing time of wounds was 14 to 32 d,with 18 d on average;the healing time of fracture was 6.3 to 13.8 months,with 10.2 months on average.Paley’s scoring system results showed that:the excellent and good rate was 86.5%including excellent in 14 cases and good in 18 cases.The results of evaluation of adjacent joint function:excellent in 11 cases,good in 19 cases,the rate of excellent and good was 81.1%.Conclusion:Compound centipedes granule combined with Ilizarov technique is safe and reliable on the treatment of postoperative infection of open tibial fracture,which is helpful to the recovery of limb function and worthy of clinical application.