载万古霉素硫酸钙在骨髓炎治疗中的应用

Application of Vancomycin-loaded Calcium Sulphate in Treatment of Osteomyelitis

目的研究载万古霉素硫酸钙在治疗骨髓炎中的作用。方法将医用硫酸钙人工骨与万古霉素混合植入24例创伤性骨髓炎患者病灶内,测量病灶局部的抗生素浓度。对创面进行细菌培养,观察患者炎症指标以及创口愈合情况。对植骨处进行X线检查,测量患者血液中万古霉素的浓度,检查肝、肾功能进行安全性评估。结果载万古霉素人工骨在病灶内局部缓释出的万古霉素浓度均超过有效治疗浓度和最低抑菌浓度,而且安全性能佳,骨髓炎治愈率100%,并可作为感染性骨不连的骨引导性材料。结论载万古霉素硫酸钙人工骨在病灶局部可以释放高浓度万古霉素,血药浓度低,安全性高,又有骨引导作用,完全符合治疗骨髓炎的要求。

Objective To investigate the role of vancomycin-loaded calcium sulphate in the treatment of osteomyelitis. Methods We implanted vancomycin-loaded calcium sulphate into 24 patients with traumatic osteomyelitis who were treated in our hospital from February 2008 to February 2010, and then the antibiotic concentrations in the lesions were measured. Bacterial culture results, inflammatory markers, as well as wound healing were observed. X-ray was performed in the location where the vancomycin-loaded calcium sulphate was implanted. The blood vancomycin level as well as liver and kidney functions were determined. Results The vancomycin concentration in the lesion exceeded the effective therapeutic concentrations and the minimum in- hibitory concentration, while the blood concentration was low. The liver and renal function remained nor- mal. The safety profile was good, and the cure rate of osteomyelitis reached 100%. Conclusions The vanco- mycin-loaded calcium sulphate can release high-concentration vancomycin in the diseased sites without causing high blood concentration. Also, it can guide the regeneration of bones. Therefore, it is effective and safe in treating osteomyelitis.