万古霉素联合自体微小颗粒骨植骨治疗感染性骨缺损的临床研究

Clinical effect of vancomycin combined with autologous bone graft of tiny particles on treatment of infective bone defects

目的探讨万古霉素联合自体微小颗粒骨植骨治疗感染性骨缺损的临床效果,以寻找最佳治疗方法,提高临床诊治水平。方法选取2010年4月-2013年4月110例感染性骨缺损患者为研究对象,将其分为对照组和观察组,各55例;对照组予自体微小颗粒骨植骨治疗,观察组在对照组基础上加用万古霉素治疗,对比两组患者治疗后临床效果的差异。结果对照组患者治疗后1～2、3～5、6～9、≥10周感染控制率分别为10.91%、18.18%、32.73%、38.18%;观察组分别为18.18%、27.27%、43.64%、10.91%;两组患者在治疗9周后白细胞计数、C-反应蛋白、血沉、肿瘤坏死因子、白介素-6方面比较差异有统计学意义（P〈0.05）;而治疗后3、6、9、12周在X线片积分差异无统计学意义。结论万古霉素联合自体微小颗粒骨植骨治疗感染性骨缺损临床效果满意,可提高骨质量,缩短骨愈合时间,促进新生骨形成,且抗菌活性高、安全性好、术中操作简单、不增加手术难度和创伤、效果稳定。

OBJECTIVE To explore the clinical effect of vancomycin combined with autologous bone graft of tiny particles on treatment of infective bone defects so as to find the optimal treatment measures and improve the clinical diagnosis and treatment.METHODS A total of 110 patients with infective bone defects who were treated in the hospital from Apr 2010 to Apr 2013 were recruited as the study objects and divided into the control group and the observation group,with 55 cases in each group.The control group was treated with the autologous bone graft of tiny particles,while the observation group was treated with additional vancomycin on the basis of the control group;the clinical effect was observed and compared between the two groups.RESULTS The rate of control of infections was 10.91%in the control group at 1-2weeks after the treatment,18.18%in the observation group;the rate of control of infections was 18.18%in the control group at 355 weeks after the treatment,27.27%in the observation group;the rate of control of infections was 32.73% in the control group at 6-9weeks after the treatment,43.64%in the observation group;the rate of control of infections was 38.18%in the control group at no less than 10 weeks after the treatment,10.91%in the observation group.There was significant difference in the white blood cells counts,C-reactive protein,erythrocyte sedimentation rate,tumor necrosis factor,or interleukin-6between the two groups at 9weeks after the treatment（P〈0.05）;however,there was no significant difference in the X-ray score between the two groups at 3,6,9,or 12 weeks after the treatment.CONCLUSIONVancomycin combined with autologous bone graft of tiny particles can achieve satisfactory clinical effect on treatment of infective bone defects,improve the quality of bone,shorten the bone healing time,facilitate the new bone formation,and have high antibacterial activity and good safety;the intraoperative operation is simple,without the increase of surgical difficulty or trauma,and the effect is stable.