皮瓣覆盖、抗生素骨水泥填充、负压封闭 灌注冲洗治疗创伤性骨髓炎 并软组织缺损的临床研究

目的 探究皮瓣覆盖、抗生素骨水泥填充、负压封闭灌注冲洗治疗创伤性骨髓炎并软组织缺损的临床效果。方法 研究对象选取江门市第二人民医院2018年3月至2019年8月收治的创伤性骨髓炎并软组织缺损患者42例，采用随机数字表法将其分为对照组 21例和观察组 21例。对照组男性13例，女性8例，年龄（39.75±15.34）岁；观察组男性15例，女性6例，年龄（38.80±15.41）岁。对照组接受常规皮瓣覆盖、负压封闭灌注冲洗治疗；观察组接受皮瓣覆盖、负压封闭灌注冲洗联合抗生素骨水泥填充治疗，两组随访1年。比较两组患者疗效、手术效果（手术时间、住院时间、换药次数、创面愈合时间、反应蛋白变化率）以及治疗前和治疗后1个月、3个月、6个月骨缺损长度、软组织缺损面积。 计量资料进行独立样本t检验，计数资料用χ2 检验。结果 观察组的治疗总有效率［90.48%（19/21）］均 明显高于对照组［61.90%（13/21）］（P<0.05）；观察组的住院时间、换药次数、创面愈合时间均少于对照组，手术时间长于对照组，反应蛋白变化率明显高于对照组（均P<0.05）；治疗后1个月、3个月、6个月， 观察组的骨缺损长度、软组织缺损面积均明显少于对照组（均P<0.05）。结论 皮瓣覆盖、抗生素骨水 泥填充、负压封闭灌注冲洗治疗创伤性骨髓炎并软组织缺损临床疗效显著，能明显改善患者骨缺损、 软组织缺损，且患者术后恢复快，经济负担小，值得在临床推广。

Clinical study on the treatment of traumatic osteomyelitis with soft tissue defect with flap covering,antibiotic bone cement filling,and negative pressure sealing perfusion irrigation

Objective To explore the clinical effect of the treatment of traumatic osteomyelitis with soft tissue defect with flap covering, antibiotic bone cement filling, and negative pressure sealing perfusion irrigation. Methods Forty-two patients with traumatic osteomyelitis and soft tissue defect admitted to Jiangmen Second People's Hospital from March 2018 to August 2019 were selected and were divided into a control group (21 cases) and an observation group (21 cases) by the random number table method. There were 13 males and 8 females in the control group, aged (39.75±15.34) years; there were 15 males and 6 females in the observation group, aged (38.80±15.41) years. The control group received conventional flap covering and negative pressure sealing perfusion irrigation, and the observation group received the treatment of flap covering, negative pressure sealing perfusion irrigation combined with antibiotic bone cement filling. Both groups were followed up for one year. The therapeutic effect, surgical effects (operation time, hospital stay, dressing change times, wound healing time, and reactive protein change rate), and bone defect length and soft tissue defect area before treatment and 1, 3, and 6 months after treatment were compared between the two groups. Independent sample t test was used for measurement data, and χ2 test was used for count data. Results The total effective rate of the observation group 90.48% (19/21)] was significantly higher than that of the control group 61.90% (13/21)] (P<0.05). The hospital stay, dressing change times, and wound healing time of the observation group were less than those of the control group, the operation time was longer than that of the control group, and the change rate of reactive protein was significantly higher than that of the control group (all P<0.05). The length of bone defect and the area of soft tissue defect in the observation group were significantly less than those in the control group 1, 3, and 6 months after treatment (all P<0.05). Conclusion The treatment of traumatic osteomyelitis with soft tissue defect with flap covering, antibiotic bone cement filling, and negative pressure sealing perfusion irrigation has significant clinical effect, which can significantly improve the patients' bone defect and soft tissue defect, with postoperative fast recovery and small economic burden, and is worthy of clinical promotion.