外固定器治疗中针道感染及其防治

外固定器治疗中针道感染及其防治贺西京李吾成陈伯伦李浩鹏陈君长外固定治疗骨折具有多方面的优点［１］，但治疗期间，始终存在着钉道感染的危险性［２］。这无疑是广泛应用外固定器治疗的主要障碍之一，急需研究防治方法，提高外固定治疗的安全性。材料与方法随机选择外...     

多根针组合半环型外固定器用于小腿开放性骨折的治疗

目的 :探讨多根针组合式半环型外固定器在用于小腿开放粉碎性骨折治疗中的价值。方法 :自 1997年 6月～ 2 0 0 0年 2月对 11例小腿开放粉碎骨折的病人 ,创面在彻底清创后 ,采用皮肤的减张缝合、小腿局部带深筋膜的旋转皮瓣与外固定器技术相结合的方法治疗。其中应用小腿皮肤减张缝合 4例 ,局部带深筋膜的旋转皮瓣修复创面 3例 ,单纯缝合 3例 ,单纯换药 1例。固定方法 :加强组合半环式外固定器治疗多段、粉碎骨折 4例 ,标准组合半环式外固定器治疗粉碎骨折 7例。结果 :8例病人创面Ⅰ期愈合 ,1例合并双小腿大面积皮肤Ⅱ°烧伤的病人 ,经换药 1个月后伤口愈合。骨折愈合时间 4～ 9个月 (平均 5 .7个月 ) ,关节功能恢复良好 ,X线显示骨折全部达到骨性愈合时拆除全部外固定器。结论 :1彻底清创消灭创面是保证骨折愈合的关键步骤。 (2 )多根针组合半环式外固定器在用于小腿开放粉碎骨折的治疗中 ,是首选的治疗方法之一 ,能随意选择穿针的位置和穿针的平面 ,远离创口病灶区和架空创面固定骨折 ,手术操作简单 ,创伤小 ,固定牢稳可靠 ,便于在各种复杂情况下对骨折进行及时复位、固定     

外固定器治疗粗隆间骨折中针道感染的防治

现就我院应用外固定器治疗股骨粗隆间骨折中防治针道感染的体会报告如下。临床资料我院应用力臂式外固定器治疗股骨粗隆间骨折１７０例，其中男８６例，女８４例；年龄３２～９３岁；手术为伤后２～１０天；术后外固定８～１５周，平均１１周。共用４ｍｍ直径骨圆针６５０根。我们把针道周围有红肿或分泌物的均列为炎症针孔，进行细菌培养、药物敏感试验及血常规检查。本组炎症的针孔为１９５／６５０。细菌培养阳性者１２例，共１６个针道，其中大肠杆菌８个，表皮葡萄球菌６个，克雷伯杆菌２个。病人的血白细胞总数及中性分类均有不同程度…     

碘伏与酒精对外固定器术后针道消毒效果比较的临床研究

外固定器在骨科临床工作中得到广泛应用，针道感染是其最常见的并发症。据报道，针道感染的发生率在0．5％～30％之间。目前临床上多用0．5％碘伏和75％酒精消毒针道，预防感染。但并未对这两种消毒剂的有效性进行分析。本研究通过对碘伏和酒精消毒效果的对比分析，以探讨其有效性。     

组合式外固定器结合小夹板固定治疗胫骨骨折

目的：采用组合式外固定器结合小夹板固定治疗胫骨骨折，并探讨其治疗疗效。方法：对164例胫骨骨折病例，早期使用组合式外固定器固定，后期改用小夹板固定，直至骨折愈合。结果：1例血运不良并感染截肢、8例骨不连、15例迟缓愈合，其余140例全部愈合。结论：外固定器与小夹板固定优势互补，手术操作简单，早期有利于皮肤创面愈合，又可克服小夹板早期固定不牢靠的缺陷；后期使用小夹板固定，能有效防止外固定器针道感染及应力遮挡，免除二次手术痛苦，是一种较好的治疗方法；但对于多发或粉碎性骨折固定欠牢固，存在局限性。     

4种消毒剂对新生儿皮肤消毒效果的观察

为了选择高效、快速且对新生儿皮肤刺激小而又不影响静脉穿刺效果的皮肤消毒剂，我院1997年3～7月对4种皮肤消毒剂进行试验，报告如下。1临床资料选择30例住院新生儿，男17例，女13例，日龄1～28d。采样前新生儿病房室温调至22～25℃，相对湿度60％～70％。采样前1h用Fusl型全自动电子消毒器（武汉福利电子仪器厂生产）消毒房间，新生儿淋浴与采样固定2名护士分别操作。30例新生儿淋浴后分别选择头部、左右手、足背4处作静脉穿刺部位，分为A、B、C、D4组，A组为对照组，B、C、D为试验组。用4种消毒剂消毒皮肤后采样共120份。A组用2％碘…     

灭菌中药敷贴预防骨折患者外固定针道感染的效果研究

目的 探讨灭菌中药敷贴预防骨折外固定治疗患者针道感染的效果。方法 选取47例临时外固定治疗的骨折患者,随机分配到试验组24例和对照组23例。试验组采用无菌中药敷贴贴于针道处,7 d更换1次;对照组使用灭菌纱布覆盖针道,以75%乙醇将纱布浸湿,每天2次,每3天更换纱布1次。比较两组针道感染率、针道局部疼痛程度及不良事件发生情况,检测白细胞计数(WBC)、C-反应蛋白值进行效果评价。结果 试验组针道感染率为4.17%,对照组为26.09%,两组比较,差异有统计学意义(P<0.05)。试验组干预后第3～7天针道局部疼痛程度显著低于对照组(均P<0.05)。两组干预后第7天C-反应蛋白值比较,差异有统计学意义(P<0.05)。试验组未发生不良事件,对照组2例发生针道周围皮肤过敏,均无严重不良事件发生。结论 采用中药敷贴应用于外固定针道护理,可有效预防外固定针道感染,降低患者疼痛程度,中药敷贴用于外固定针道护理的效果显著。     

灭菌中药敷贴预防骨折患者外固定针道感染的效果研究

目的 探讨灭菌中药敷贴预防骨折外固定治疗患者针道感染的效果。方法 选取47例临时外固定治疗的骨折患者,随机分配到试验组24例和对照组23例。试验组采用无菌中药敷贴贴于针道处,7 d更换1次;对照组使用灭菌纱布覆盖针道,以75%乙醇将纱布浸湿,每天2次,每3天更换纱布1次。比较两组针道感染率、针道局部疼痛程度及不良事件发生情况,检测白细胞计数（WBC）、C-反应蛋白值进行效果评价。结果 试验组针道感染率为4.17%,对照组为26.09%,两组比较,差异有统计学意义（P＜0.05）。试验组干预后第3～7天针道局部疼痛程度显著低于对照组（均P＜0.05）。两组干预后第7天C-反应蛋白值比较,差异有统计学意义（P＜0.05）。试验组未发生不良事件,对照组2例发生针道周围皮肤过敏,均无严重不良事件发生。结论 采用中药敷贴应用于外固定针道护理,可有效预防外固定针道感染,降低患者疼痛程度,中药敷贴用于外固定针道护理的效果显著。     

应用单侧多针平行双平面外固定器治疗四肢骨折

本报告58例应用单侧多针平行双平面骨外固定器治疗四肢骨折的临床结果。结果提示：应用单侧多针平行双平面骨外固定器治疗伴严重软组织损伤的开放性骨折、邻近关节部位的骨折、需牵引维持肢体长度的骨折、需手术治疗的小儿股骨骨折等临床效采良好。该固定器轻便、竹廉、功能多样、操作简单、方便，适用于各级医院推广运用。     

微型多功能可调式锁针外固定器的研制及在桡骨远端粉碎性骨折中的应用

目的探讨自制微型多功能可调式锁针外固定器在治疗桡骨远端粉碎性骨折中的临床疗效和应用价值。方法自2005年7月～2008年12月,采用自制微型多功能可调式锁针外固定器治疗桡骨远端严重粉碎性骨折32例。按AO/ASIF分型:A3型9例,C2型7例,C3型16例,其中开放性5例。治疗采用闭合复位加外固定15例,切开复位加外固定17例,植骨10例。受伤至手术时间为2h～5d,平均3.5d。结果术后随访5～40个月,按照解剖学上的恢复结果,解剖复位8例,功能复位22例,接近功能复位2例。术前尺偏角为-20～10°(平均-10°),掌倾角为-40～0°(平均-12°),术后尺偏角15～25°(平均20°),掌倾角为8～15°(平均12°)。关节功能疗效按Dienst功能评估标准进行评定:优12例,良19例,可1例。无针道及伤口感染,无针孔骨折,无医源性神经血管损伤,无骨不连等并发症。结论自制微型可调式锁针外固定器是治疗桡骨远端严重粉碎性骨折的一种较好方法,其操作简单,固定可靠,价格低廉,疗效满意,并发症少,为桡骨远端严重粉碎性骨折的治疗提供了一种新方法。     

The Kickstand Technique for Circular External Fixator Assembly

External fixation has been shown to be an extremely versatile tool for surgical reconstruction of the lower extremity. Modern circular-ring fixators, based on original Ilizarov design, are widely used for their stiffness, utility, adjustability, and effectiveness. Because of the full-radius enclosure of the limb, however, it can be difficult to place the fixator on a supine patient. Our institutions have used a useful technique to aid application of the fixator by suspending the limb several centimeters above the operating table.     

微型外固定支架的临床应用

目的：应用微型外固定支架治疗上肢短骨骨折。方法：本组１２例１５处骨折，均采用手法或切开复位，微型外固定支架固定。结果：本组骨折全部愈合。随访６～１２月，骨折无移位，无断钉及外固定架松动，关节稳定，活动范围正常。３例钉孔有少量渗出，拆除固定钉后钉孔即愈合，无深部感染。结论：微型外固定器体积小，重量轻，稳定性好，损伤小，可以进行早期功能锻炼，关节功能佳，是治疗上肢短骨骨折一种较为理想的固定器材。     

儿童闭合性胫腓骨骨折的外固定架治疗

目的探讨儿童闭合性胫腓骨骨折Orthofix单臂外固定架治疗的疗效,分析外固定架治疗的优缺点。方法 2001年8月～2008年11月,应用单臂外固定架(Orthofix SRL公司)治疗169例儿童胫腓骨骨折,其中单侧闭合骨折97例纳入本组。采用在C形臂或G形臂透视下进行闭合复位,Orthofix外固定架固定。结果手术时间35～160min,平均54min;出血量都在10ml以下。17例固定过程中出现Ⅰ～Ⅱ级针道感染,通过换药等手段控制,无一例因针道感染导致外固定架失效。固定过程中膝关节及踝关节活动均不受影响。骨性愈合时间12～24周,平均14.2周。23例过度生长不超过1cm。97例术后随访15～39个月,平均31个月,骨折全部骨性愈合。结论应用外固定架治疗儿童闭合性胫腓骨骨折,不破坏骨折端血运,且可提供牢固固定,允许早期关节活动及负重练习,减轻了护理负担。     

胫骨骨折外固定器固定与内固定疗效比较

目的：探讨单侧简易外固定器与内固定治疗胫骨骨折疗效。方法：６５例胫骨骨折随机２组,１组３７例行外固定器固定,另１组２８例行内固定,从平均住院日、骨折愈合时间、并发症３个方面进行比较分析,结果：外固定器组平均骨折愈合时间４．２月,平均住院日短,并发症少。结论：单侧简单易外固定器固定治疗胫骨骨折疗效优于内固定组。     

Adding a First Metatarsal Pin to An Ankle Tubular External Fixator Does Not Reduce the Incidence of Early Reduction Loss

External fixation with a bilateral frame configuration (delta frame, DF) is a routine approach for treating ankle fractures and dislocations with severe soft tissue damage. The purpose of this study was to evaluate to what extent adding a first metatarsal fixation contributes to the stability of the fixation as evidenced by reduced frequency of early loss of reduction. A retrospective study was performed to compare the rate of early reduction loss in patients treated with a bilateral frame external fixation as part of a 2-stage treatment protocol for periarticular ankle fractures, in a level one trauma center between 2006 and 2016. The cohort was divided into 2 groups according to the frame configuration that had been used: DF only and DF with first metatarsal fixation (DF+1MT). A multivariate analysis assessing risk factors for postoperative loss of reduction was conducted. A total of 67 patients were included in the study, of which 30 underwent fixation by DF and 37 by DF+1MT. Early loss of reduction was recorded in 13 (19.4%) patients, 6 (20%) in the DF group and 7 (18.9%) in the DF+1MT group (p = .576). None of the assessed risk factors reached statistical significance. To conclude, the addition of a first metatarsal pin as an enhancement of external fixation with a delta frame configuration did not reduce the incidence of early loss of reduction. There is no evidence to support the claim that adding this pin contributes to the stability of the fixation in a clinically relevant manner.     

外固定架在三关节融合术中的应用

目的：应用外固定支架逐步矫正行三关节融合术，探讨其可行性。方法：本组６例６足，年龄１３岁－２５岁，均为足下垂角度大，且合并有血管及神经并发症。行三关截骨，用外支架逐步矫正达到三关节融合。结果；本组全部病例三关节融合良好。无１例出现血管及神经损伤严重并发症。１例行走时轻微疼痛，跛行。２例针孔少量渗出，拔针后愈合，无深部感染。     

Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures

BackgroundTibia fracture is the most common long bone fracture. The fractures of tibia are commonly open fractures due to subcutaneous position of the tibia. The choice of technique for stabilization of open tibia fractures includes - External fixation, unreamed intra-medullary nails [URTN], Reamed intra-medullary nails, ORIF with Plating.ObjectivesTo evaluate & compare the results of Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures.MethodsThis prospective clinical study [Randomized chit box] was done on 50 patients presenting to our institute within 24 h of injury. Only those who were skeletally mature with open tibia fracture Grade IIIA & IIIB [Gustilo-Anderson] were included in this study. After initial management, radiological assessment was done. Following this adequate wound debridement, skeletal stabilization with either primary URTN or external fixator was done. Inspection and debridement were repeated at 48-h intervals until the wound was considered clean.Results50 cases [25 each group] were compared in terms of - Final Alignment of the Fracture, Presence of Infection/Non-union/Mal-union, Hardware failure, Time to Bone Union, Number of Operative Procedures after index admission. Mean time to full weight bearing was 20.96 weeks in URTN group versus 24.8 weeks in Ex-fix group. 5 in URTN group required further surgery for non-union versus 11 patients in Ex-fix group. There were 6 significant pin track infection. Removal of nail was required in 1 case of deep infection.ConclusionThis study supports the use of the URTN over External fixator in the treatment of severe open tibia fractures.     

Tibiocalcaneal Arthrodesis Using a Simple External Fixator

Tibiocalcaneal arthrodesis has been a salvage option for conditions with extensive loss of the talar body. In conditions that preclude the use of internal fixation, external compression arthrodesis has been the preferred technique to achieve fusion about the hindfoot. Since Sir John Charnley elucidated the technique of compression arthrodesis using compression clamps, various modifications and techniques of external compression arthrodesis have been described. Various clinical and biomechanical studies have established the superiority of triangular transfixation in external compression arthrodesis. We have described a simple technique of compression arthrodesis after the principle of triangular transfixation using easily available hardware from Ilizarov instrumentation. This technique is relatively inexpensive in terms of the cost of the materials, uses a modular construct, and allows multiplanar correction of the hindfoot. It can be used intraoperatively to distract the hindfoot joints, especially in the presence of fibrosis and poor skin conditions. We believe this device can be a reasonable alternative to the conventional external fixation techniques for tibiocalcaneal arthrodesis.