抗生素硫酸钙联合外固定支架对开放性胫骨骨折患者治疗效果及并发症影响

Therapeutic efficacy of antibiotic and calcium sulfate combined with external fixator in patients with open tibial fractures and its effect on complications

目的:观察应用抗生素硫酸钙对开放性胫骨骨折患者的治疗效果以及对并发症的影响。方法:纳入2020年3月-2023年3月东阳市红会医院和东阳花园田氏医院骨科收治的69例开放性胫骨骨折患者,采用随机数表法分为对照组(n=34)和观察组(n=35)。对照组采用常规清创、C型臂X线机透视下行轴向牵引、骨折复位、外固定支架固定等对症治疗,观察组在对照组的基础上联合抗生素硫酸钙。对比两组患者治疗后的临床疗效、膝关节功能评分(HSS)、踝关节功能评分(Mazur)、肿瘤坏死因子(TNF-α)、白细胞介素1β(IL-1β)、并发症发生率及临床恢复时间。结果:治疗后观察组总有效率97.14%高于对照组82.35%,差异有统计学意义(P<0.05);两组患者HSS、Mazur评分较前升高(P<0.05),且观察组改善更明显[(71.88±4.25)分vs(64.07±4.18)分,(76.58±5.36)分v(s 70.19±5.13)分],差异有统计学意义(P<0.05);两组患者TNF-α、IL-1β水平低于治疗前,且观察组改善更明显[(48.41±5.57)pg·mL^(-1) vs(59.45±5.54)pg·mL^(-1),(140.73±20.25)pg·mL^(-1) vs(169.26±20.31)pg·mL^(-1)],差异有统计学意义(P<0.05);观察组并发症发生率5.71%低于对照组23.53%,差异有统计学意义(P<0.05);观察组骨折愈合时间、外固定架拆除时间、住院时间均短于对照组[(121.27±18.08)d vs(135.19±17.14)d,(123.48±18.46)d vs(137.57±18.34)d,(29.17±3.24)d vs(35.16±3.18)d],差异有统计学意义(P<0.05)。结论:抗生素硫酸钙联合外固定支架治疗开放性胫骨骨折患者有较高疗效,能改善患者膝踝关节功能,降低炎症水平、并发症的发生率,促进患者临床恢复。

Objective:To investigate the therapeutic efficacy of antibiotic and calcium sulfate combined with external fixator in patients with open tibial fractures and its effect on complications.Methods:Sixty-nine patients with open tibial fractures admitted to Dongyang Red-cross Hospital and Tianshi Hospital,Dongyang Garden from March 2020 to March 2023 were enrolled in this study and randomized into the control group(n=34)and the observation group(n=35).The patients in the control group were treated with conventional symptomatic therapy and external fixator.Based on this,the patients in the observation group were treated with addition of antibiotic and calcium sulfate therapy.Then the clinical efficacy,hospital for special surgery knee score(HSS),Mazur’s functional ankle score,tumour necrosis factor-α(TNF-α),interleukin-1β(IL-1β),complication rate and clinical recovery time were compared between the 2 groups.Results:The Observation group reported a higher clinical efficacy rate as compared to control group(97.14%vs 82.35%,P<0.05).An increase in HSS and Mazur’s functional ankle score was observed in all patients after treatment,and the observation group scored higher than theh control[(71.88±4.25)vs(64.07±4.18),(76.58±5.36)vs(70.19±5.13),P<0.05].Serum levels of TNF-αand IL-1βshowed a decrease in all patients after treatment,and they were lower in theh observation group than in the control[(48.41±5.57)pg·mL^(-1) vs(59.45±5.54)pg·mL^(-1),(140.73±20.25)pg·mL^(-1) vs(169.26±20.31)pg·mL^(-1),P<0.05].The complication rate was 5.71%in the observation group,which was lower than 23.53%in the control(P>0.05).The fracture healing time,the removal time of external fixator and the length of stay were all shorter in the observation group as compared to the control[(121.27±18.08)d vs(135.19±17.14)d,(123.48±18.46)d vs(137.57±18.34)d,(29.17±3.24)d vs(35.16±3.18)d,all P<0.05].Conclusion:The pplication of antibiotic and calcium sulfate combined with external fixator in patients with open tibial fractures can effectively improve the knee and ankle joint function,attenuate inflammation response,reduce complications,and promote clinical recovery of patients.