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. 2017 Nov 15;31(11):1281-1286.
doi: 10.7507/1002-1892.201706066.

[Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities]

[Article in Chinese]
Yao Lu  1 , Rungong Yang  2 , Jialiang Zhu  3 , Lin Yang  3 , Yuzhe Bai  3 , Rigeleng Se  3 , Yaoqi Ying  3
Affiliations

[Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities]

[Article in Chinese]
Yao Lu et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To explore the effectiveness of plasma-mediated bipolar radiofrequency ablation debridement (Coblation debridement) in treatment with retention of internal fixation for early postoperative infection of fractures of extremities.

Methods: Between January 2012 and May 2015, 16 patients (12 males and 4 females) with early postoperative infection of internal fixation for extremity fracture were treated, with an average age of 41.6 years (range, 19-61 years). The fractures included tibia and fibula fracture in 5 cases, femoral fractures in 5 cases, distal humeral fractures in 3 cases, ulna and radius fractures in 2 cases, and patellar fracture in 1 case. Two cases were open fractures and 14 cases were closed fractures. All fractures were fixed non-intramedullarily. Postoperative infection occurred at 5-10 days (mean, 7 days) after operation, with bacteria cultured from wound secretion in all cases. Type EIC5872 70 Coblation knife and Coblator Ⅱ plasma surgery system were conducted to debride the foci of infection in ablating pattern with sterile saline used as the conductive fluid and the magnitude of power from 6 to 9. After pulse irrigating with sterile saline, irrigating tube and draining tube were placed beside the fixation. Postoperative continuous irrigation and drainage and systemic antibiotic therapy would be conducted. The effectiveness was evaluated by bone infection effectiveness evaluation criteria.

Results: All the 16 patients were followed up 12-36 months (mean, 15 months) after operation. All the infected wounds were cured and healed by first intention without recurrence in all the patients, and the fracture healing time was 3-7 months (mean, 4.8 months) without limb dysfunction or nonunion. Internal fixation was removed at 1-2 years after operation in 4 cases, whom with good fracture healing and without recurrence of infection after operation.

Conclusion: The effectiveness of Coblation debridement in treatment with retention of internal fixation for early postoperative infection of extremity fractures are satisfactory, which can avoid the second stage operation, infectious nonunion, and osteomyelitis.

目的: 探讨等离子射频清创在四肢骨折术后早期感染保留内固定物治疗中的应用及临床疗效。.

方法: 2012 年 1 月—2015 年 5 月收治四肢骨折内固定术后早期感染患者 16 例，男 12 例，女 4 例；年龄 19～61 岁，平均 41.6 岁。胫腓骨骨折 5 例，股骨骨折 5 例，肱骨远端骨折 3 例，尺桡骨骨折 2 例，髌骨骨折 1 例。其中开放骨折 2 例，闭合骨折 14 例。骨折后均采用非髓内固定手术方式，内固定术后 5～10 d，平均 7 d 发生感染，伤口分泌物培养出致病菌。对所有患者在保留内固定物的前提下，应用 EIC5872 70 型等离子射频消融刀头和 CoblatorⅡ型等离子手术系统，采用消融模式清除感染病灶，强度选择在 6～9 档；手术过程中使用无菌生理盐水作导电液；病灶清除后脉冲冲洗伤口，并在内固定物表面放置灌洗管和引流管，术后持续灌洗引流并全身抗感染治疗。采用骨感染疗效判定标准评价疗效。.

结果: 术后患者伤口均Ⅰ期愈合。16 例患者均获随访，随访时间 12～36 个月，平均 15 个月。所有伤口均治愈，无感染复发。X 线片示骨折均达临床愈合，愈合时间 3～7 个月，平均 4.8 个月，未出现肢体功能障碍或骨不连。其中 4 例于术后 1～2 年取出内固定物，骨折愈合良好，术后无感染复发。.

结论: 等离子射频清创在保留内固定物的前提下，治疗内固定术后早期感染效果确切满意，可有效避免二期手术内固定、感染性骨不连及骨髓炎的发生。.

Keywords: Plasma-mediated bipolar radiofrequency ablation; debridement; fracture; internal fixation; postoperative infection.

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Figures

图 1
图 1
A typical case 典型病例
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