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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～ 10d,平均7d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Coblator Ⅱ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.“,”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.