摘要
目的探讨高压氧(HBO)联合负压封闭引流(VSD)技术治疗早期骨筋膜室综合征(OCS)患者46例的临床效果,并分析肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)对病情变化的预测价值。方法回顾性分析2015年9月至2020年3月烟台市烟台山医院骨科收治的89例早期OCS患者的临床资料,根据治疗方法分为观察组(n=46)和对照组(n=43)。对照组在常规对症治疗的基础上予以VSD治疗;观察组则在对照组治疗的基础上联合HBO治疗。治疗3个疗程后,比较2组患者的临床疗效;采用疼痛视觉模拟评分(VAS)评价患者治疗前后疼痛情况;记录2组患者肿胀消退时间和住院时间;观察患肢切口部位肉芽组织新鲜度及感染情况,综合判断是Ⅰ期缝合还是Ⅱ期伤口植皮;酶联免疫吸附法检测不同时间点血清IL-6、TNF-α表达水平,并预测OCS病情变化。结果治疗3个疗程后,观察组患者的治疗有效率(97.8%)明显高于对照组(81.4%),差异有统计学意义(P<0.05)。观察组患者Ⅱ期伤口植皮率(53.5%)明显低于对照组(21.7%),肉芽组织无感染率(80.4%)明显高于对照组(51.2%),差异均有统计学意义(P<0.05)。观察组患者肿胀消退时间[(13.14±3.42)d]和住院时间[(16.55±3.52)d]均明显短于对照组消退时间[(22.39±4.48)d]和住院时间[(26.87±5.51)d],差异均有统计学意义(P<0.05)。观察组患者术后7、14、21 d VAS明显低于对照组,差异有统计学意义(P<0.05)。观察组患者术后7、14 d血清TNF-α和IL-6水平明显低于对照组,差异均有统计学意义(P<0.05);但2组患者术后21 d血清TNF-α和IL-6水平比较差异无统计学意义(P>0.05)。结论HBO联合VSD治疗早期OCS可以改善患肢血液循环,降低切口感染,促进切口愈合,减轻肢体疼痛,提高治疗效果。
Objective To investigate the clinical efficacy of hyperbaric oxygen(HBO)combined with vacuum sealing drainage(VSD)in the treatment of 46 patients with early osteofascial compartment syndrome(OCS),and to analyze the value of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)for prognostic prediction.Methods A total of 46 patients with early OCS admitted to the Department of Orthopedics of Yantai Mountain Hospital from September 2015 to March 2020 were retrospectively analyzed.According to the treatment methods,they were divided into observation group(n=46)and control group(n=43).The control group was treated with VSD and conventional symptomatic treatment,while the observation group was treated with HBO on the basis of the treatments of the control group.The clinical efficacy was compared after 3 courses of treatment.The pain was graded before and after treatment by visual analogue scale(VAS);the time of swelling subsiding and length of hospital stay were respectively recorded;the freshness and infection of granulation tissue at the incision site of the affected limb were observed,and primary suture or secondary skin grafting was conducted based on evaluation;enzyme linked immunosorbent assay(ELISA)was applied to measure the levels of serum TNF-α and IL-6 at different time points for the prediction of the development of the disease.Results After 3 courses of treatment,the effective rate of the observation group(97.8%)was significantly higher than that of the control group(81.4%)(P<0.05).The secondary skin grafting rate in the observation group(53.5%)was significantly lower than that in the control group(21.7%),and the rate of granulation tissue without infection(80.4%)was significantly higher than that of the control group(51.2%)(P<0.05).The time of swelling subsiding[(13.14±3.42)d]and length of hospital stay[(16.55±3.52)d]in the observation group were significantly lower than those in the control group[time of swelling subsiding:(22.39±4.48)d;length of hospital stay:(26.87±5.51)d](P<0.05).The VAS scores of the observation group were significantly lower than those of the control group on the 7th,14th,and 21st days after operation(P<0.05).The levels of serum TNF-α and IL-6 in the observation group were significantly lower than those in the control group on the 7th and 14th days after operation(P<0.05),but no significant difference was observed on the 21st day(P>0.05).Conclusion HBO combined with VSD in the treatment of early OCS can improve the blood circulation of the affected limb,reduce the incidence of incision infection,promote wound healing,and reduce limb pain,so as to improve the curative effect.
作者
成功
曲文庆
曹志林
吴浩
褚楷
张同庆
赵勇
曲光
Cheng Gong;Qu Wenqing;Cao Zhilin;Wu Hao;Chu Kai;Zhang Tongqing;Zhao Yong;Qu Guang(Department of Orthopedics,Yantai Mountain Hospital,Yantai 264000,China)
出处
《中华航海医学与高气压医学杂志》
CAS
CSCD
2020年第6期654-658,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
基金
山东省医药卫生科技发展计划资助项目(2019WS269)
山东省重点研发计划资助项目(2018GSF118186)。
关键词
高压氧
负压封闭引流
早期骨筋膜室综合征
Hyperbaric oxygen
Vacuum sealing drainage
Early osteofascial compartment syndrome
