吻合血管腓骨皮瓣移植与万古霉素硫酸钙填塞治疗慢性胫骨骨髓炎并骨缺损

Clinical comparison of vascularized fibular flap transplantation with vancomycin calcium sulfate in treatment of chronic osteomyelitis and bone defects

目的:比较吻合血管腓骨皮瓣移植法与万古霉素硫酸钙填塞法治疗慢性胫骨骨髓炎并骨缺损的临床疗效。方法:我院35例慢性胫骨骨髓炎并骨缺损患者,分别接受吻合血管的腓骨皮瓣移植法(A组21例)或万古霉素硫酸钙填塞法(B组14例),比较两组感染控制率及Enneking系统评分,同时检测术前与术后2周、术后1及3个月的CRP及PCT水平。结果:两组患者术后CRP及PCT均能控制,术前与术后2周、术后1及3个月比较,差异有统计学意义。在感染控制率上两组对比差异无统计学意义(P>0.05),术后Enneking评分上相比差异有统计学意义(P<0.05)。结论:两种方法临床疗效均满意,应视患者感染的程度和骨缺损的长短选择合适的治疗办法,有时联用两种治疗方法更值得推荐。

Objective To compare the clinical effect of vascularized fibular flap transplantation and vancomycin sulfate calcium on chronic osteomyelitis of the tibia and bone defects. Methods A total of 35 cases with chronic tibial osteomyelitis and bone defect were involved and divided into group A with 21 cases receiving anastomosis of vascularized fibular flap transplantation and group B with 14 cases receiving vancomycin sulfate calcium. Infection control rate and Enneking score were compared in both groups. Simultaneous detection of two groups preoperative, postoperative 2 weeks, 1 month and 3 months of the levels of CRP and PCT were conducted. Results Postoperative CRP and PCT were under control in both groups. No statistical significance was found in the comparison of CRP and PCT preoperative and postoperative 2 weeks, 1 month and 3 months. In terms of infection control rate, two groups had no significant difference （P 〉 0.05 ） and there was statistical significance of the comparison of postoperative Enneking score （P 〈0.05）. Conclusions The clinical results of the two methods are satisfied. The infection degree and the length of the bone defect are decisive factors in choosing the treatment method and sometimes the combination of two treatment methods may be a better choice.