托里消毒散结合骨搬移手术治疗慢性骨髓炎的疗效观察

Clinical observation of Tuoli Xiaodu San combined with bone transfer operation in the treatment of chronic osteomyelitis

目的:评价托里消毒散结合骨搬移手术治疗慢性骨髓炎患者的临床疗效。方法:纳入了2017年10月至2020年12月在甘肃省中医院就诊的胫骨慢性骨髓炎患者48例,患者接受骨搬移手术治疗,并在损伤早期、中期和后期给予基于托里消毒散加减中药治疗。观察所有患者的创面愈合情况,记录骨愈合时间、外固定指数和骨搬运速度。在治疗前后,分别运用踝与后足功能(AOFAS)评分系统和美国特种外科医院(HSS)评分评估踝关节与膝关节功能,运用健康调查简表(SF-36)评价生活质量。依据Paley骨性愈合标准和功能恢复标准评价临床疗效,计算优良率。结果:平均骨愈合时间是(214.7±52.1)d,外固定指数是(36.4±7.5)d/cm,骨搬运速度是(12.8±3.1)d/cm。术后骨愈合时的平均AOFAS评分和HSS评分均较治疗前显著增高(P<0.01),SF-36各项评分也显著增高(P<0.05)。根据Paley骨性愈合标准,整体优良率是95.8%(46/48);根据Paley功能恢复标准,整体优良率是97.9%(47/48)。治疗期间共观察到钉道感染2例,对接端愈合不良1例,并发症发生率为6.25%(3/48)。结论:托里消毒散结合骨搬移手术治疗慢性骨髓炎,能够有效控制创面感染,促进骨愈合,改善关节功能,提高生活质量,并减少骨髓炎复发。

Objective:To evaluate the clinical efficacy of Tuoli Xiaodu San combined with bone transfer in the treatment of chronic osteomyelitis.Methods:A total of 48 patients with chronic osteomyelitis of the tibia were hospitalized in Gansu Provincial Hospital of Traditional Chinese Medicine from October 2017 to December 2020 were included in this study.These patients received bone transfer operation,and received traditional Chinese medicine treatment based on Toli Xiaodu San in the early,middle and late stages of injury.Observed the wound healing of all patients,and record the bone healing time,external fixation index and bone transport speed.Before and after treatment,AOFAS ankle hindfoot scale and hospital for special surgery(HSS)scores were used to evaluate ankle and knee joint functions respectively,and the MOS item short from health survey(SF-36)was used to evaluate the quality of life.The clinical efficacy was evaluated according to Paley bone healing criteria and functional recovery criteria,and the excellent and good rate was calculated.Results:The average follow-up time was(15.1±4.3)months without loss of follow-up.The average bone healing time was(214.7±52.1)d,the external fixation index was(36.4±7.5)d/cm,and the bone transport speed was(12.8±3.1)d/cm.The mean AOFAS score and HSS score of bone healing after treatment were significantly higher than those before treatment(P<0.01),and the scores of SF-36 sub items were also significantly higher(P<0.05).According to the Paley bone healing standard,the overall excellent and good rate was 95.8%(46/48);According to the Paley functional recovery standard,the overall excellent and good rate was 97.9%(47/48).During the treatment,2 cases of nail infection and 1 case of poor union of butt joint were observed.The complication rate was 6.25%(3/48).Conclusion:Tuoli Xiaodu San combined with bone transfer operation can effectively control wound infection,promote bone healing,improve joint function,enhance quality of life,and reduce recurrence of osteomyelitis.