抗生素骨水泥链珠与灌注冲洗治疗慢性骨髓炎的对比研究

Retrospective clinical comparison of antibiotic-PMMA beads versus continuous perfusion in the treatment of chronic osteomyelitis

[目的]对比分析应用抗生素骨水泥链珠与传统灌注冲洗治疗慢性骨髓炎的临床疗效。[方法]回顾2007年1月～2009年12月本院55例胫骨慢性骨髓炎患者,其中30例(A组)接受抗生素骨水泥链珠治疗;另外25例(B组)采用灌注冲洗手术治疗。比较两组各项指标,包括住院日、手术时间、出血量、术后下地时间、伤口愈合时间、C反应蛋白变化率及视觉疼痛模拟(VAS)评分。[结果]与传统组相比,抗生素骨水泥链珠组手术各项指标包括:住院日、术后出血量、术后下地时间、伤口愈合时间、C反应蛋白变化率均优于传统组(P<0.05),所有患者均获2年以上随访。抗生素骨水泥链珠组在术后6、12、24、48 h(VSA)评分均显著优于传统组(P<0.01),术前及术后72 h(VSA)评分两组无明显差异(P>0.05)。[结论]抗生素骨水泥链珠与灌注冲洗均是治疗慢性骨髓炎的有效术式,但抗生素骨水泥链珠治疗出血少、恢复快、疗效肯定,是一种安全、可靠的技术。

[ Objective ] To compare the clinical effect of antibiotic - PMMA beads versus continuous perfusion in the treatment of chronic osteomyelitis. [ Method]From Jan. 2007 to Dec. 2009, a total of 55 patients with chronic osteomyelitis in tibia were divided into 2 groups. Thirty cases in group A underwent antibiotic - PMMA beads and others in group 2 underwent continuous perfusion. Hospitalization days, operation time, blood loss, volume of draining after operation, time of ambulation, wound healing time, changing rate CRP and VAS （visual analogue score）were assessed. [ Result ] Hospitalization days, volume of drai- ning after operation, time of ambulation, wound healing time, changing rate CRP were significantly better for group A than group B （ P 〈 0.05 ）. All patients were followed up for two years. In patients VSA score showed significantly better improvement at postoperation 6 hour, 12 hour,24 hour,48 hour for group A versus group B （ P 〈 0. 01 ） , hut were similar at preoperation and 72 hour postoperation（P 〉 0.05 ）. [ Conclusion] Our data suggest that the two procedures yield comparable result in terms of clinical outcomes for the treatment of chronic osteomyelitis. However, the treatment of antibiotic-PMMA beads could show less blood loss, accelerated recovery and satisfying effect. It is a safe and reliable technique.