慢性骨髓炎的造影表现及动脉内药物灌注

Chronic osteomyelitis and therapic effect by transcatheter arterial infusion

目的观察经导管灌注治疗慢性骨髓炎的疗效.方法 29例患者术前行药敏试验,无法取得药敏试验者用高效广谱抗生素.采用Seldinger穿刺置管并造影确定管头位置后回病房,用微量泵注入抗生素,置管时间3～9天不等.血供差者适当给予扩血管及疏通微循环药.结果 13例经灌注治疗后症状明显改善,成功地进行了手术治疗(45%),15例完全治愈出院(51%),1例绿脓杆菌感染者因创面大效果差而截肢.随访25例41天至4年,其中4例复发者均为单纯灌注者.结论动脉内药物灌注治疗慢性骨髓炎方法简单,实用性强,疗效可靠,缩短了治疗时间.通过造影了解病灶周围的血管情况,对临床吻合血管的选择具有指导意义.

Objective To observe therapetic effect of transcatheter arterial infusion (TAI) in treating chronic osteomyelitis. Methods Twenty-nine patients with chronic osteomyeoitis were treated by TAI, 24 of them had external injury or infected after surgery, 5 had no definite cause. Drug sensistivity was tested before operation. Digital subtraction angiography (DSA) was used to locate and insert the catheters for interventional therapy. The antibiotics were injected slowly by micro pump. The curing time ranged from 3 to 9 days. The patients with poor blood supply were pretreated with drugs to enlarge blood vessels and improve microcirculation. Results Among 29 patients, 13 were improved greatly by surgery (45%), 15 were discharged after complete heal (51%). One patient with large area of imfection by aeruginosus bacillus was amputated because of poor therapeutic effect. Twenty-five patients were followed up for 41 days to 4 years. Recurrence occurred in 4 of them. Conclusion Interventional arterial indwelling catheter is a simple but effective method for the treatment of chronic osteomyelitis. The application of DSA is very important in the therapy.