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| 低刺激针道处理改善儿童骨外固定耐受性 |
| Application of Low-Irritation Pin Tract Care in Pediatric Open Fractures |
| 投稿时间：2026-04-13 修订日期：2026-07-02 |
| DOI： |
| 中文关键词: 儿童 开放性骨折 骨外固定 针道局部处理 局部综合耐受性指数 感染 |
| 英文关键词: children open fracture external fixation pin-site care Composite Local Tolerance Index infection |
| 基金项目:安徽省中医药学会中医药科研项目 |
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| 中文摘要: |
| 目的 探讨低刺激针道局部处理路径在儿童四肢开放性骨折骨外固定术后局部耐受性改善中的应用价值,并分析术后6周不良局部耐受的相关因素。方法 采用单中心回顾性队列研究,纳入2022年1月至2024年1月于安徽省儿童医院小儿骨科病区接受四肢开放性骨折骨外固定治疗的患儿428例,按术后首次针道局部处理方式分为对照组210例和观察组218例。对照组采用75%酒精常规处理联合无菌纱布局部覆盖,观察组采用生理盐水清洁联合银离子敷料覆盖。比较两组术后2、6、12周局部综合耐受性指数(CLI)及其构成指标,并比较局部接触性皮炎、Ⅱ级及以上针道感染、住院时间、外固定留置时间、关节活动度(ROM)及疼痛缓解速率。结果 两组基线资料差异均无统计学意义(均 P >0.05)。观察组术后2、6、12周CLI总分及其各构成指标均优于对照组,经Bonferroni校正后差异仍有统计学意义(均 P <0.017)。观察组局部接触性皮炎发生率(5.5%比15.7%)和Ⅱ级及以上针道感染发生率(2.8%比7.1%)均低于对照组(P=0.001、0.044)；住院时间、外固定留置时间短于对照组,12周ROM及疼痛缓解速率优于对照组(均 P <0.001)。多因素Logistic回归分析显示,低刺激针道局部处理路径为术后6周不良局部耐受的保护因素(OR =0.057,95% CI :0.034~0.095, P <0.001)；BMI升高及受伤至手术时间延长为危险因素,Gustilo Ⅰ~Ⅱ型为保护因素。结论 生理盐水清洁联合银离子敷料覆盖可显著改善儿童四肢开放性骨折骨外固定术后局部耐受性,降低局部接触性皮炎及Ⅱ级及以上针道感染发生风险,并有助于促进短期功能恢复 。 |
| 英文摘要: |
| Objective To investigate the value of a low-irritation pin-site care pathway in improving local tolerance after external fixation in children with open fractures of the extremities and to analyze factors associated with poor local tolerance at 6 weeks postoperatively. Methods A single-center retrospective cohort study was conducted in 428 children with open fractures of the extremities who underwent external fixation in the Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, from January 2022 to January 2024. According to the initial postoperative pin-site care strategy, 210 patients were assigned to the control group and 218 to the observation group. The control group received routine 75% alcohol disinfection combined with sterile gauze coverage, whereas the observation group received normal saline cleansing combined with silver dressing coverage. The Composite Local Tolerance Index (CLI) and its component scores were compared between the two groups at 2, 6, and 12 weeks after surgery. Contact dermatitis, grade II or higher pin-site infection, length of hospital stay, duration of external fixation, range of motion (ROM), and pain relief rate were also compared. Results No significant differences were found in baseline characteristics between the two groups (all P >0.05). At 2, 6, and 12 weeks after surgery, the observation group showed better CLI total scores and all component scores than the control group, and the differences remained significant after Bonferroni correction (all P <0.017). The incidences of contact dermatitis (5.5% vs. 15.7%) and grade II or higher pin-site infection (2.8% vs. 7.1%) were both lower in the observation group than in the control group (P =0.001 and 0.044, respectively). The observation group also had shorter hospital stay and external fixation duration, and showed better ROM and pain relief rate at 12 weeks (all P <0.001). Multivariate logistic regression analysis showed that the low-irritation pin-site care pathway was a protective factor for poor local tolerance at 6 weeks postoperatively (OR =0.057, 95% CI: 0.034-0.095, P <0.001), whereas higher BMI and longer time from injury to surgery were risk factors; Gustilo type I-II was a protective factor. Conclusion Normal saline cleansing combined with silver dressing coverage can significantly improve local tolerance after external fixation in children with open fractures of the extremities, reduce the risks of contact dermatitis and grade II or higher pin-site infection, and promote short-term functional recovery |
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