一期彻底清创负载抗生素硫酸钙治疗跟骨骨髓炎

Treatment of calcaneus osteomyelitis by one-stage debridement and compound grafting of antibiotic-impregnated calcium sulfate

目的探讨运用一期彻底清创负载抗生素硫酸钙治疗跟骨骨髓炎的效果。方法从2012年06月~2014年12月共收治21例跟骨骨髓炎患者,男15例,女6例;年龄(33~55)岁,平均(43.71±6.73)岁,跟骨骨髓炎病史(1~36)个月,平均(12.67±9.62)个月,Cierny-Mader分型:Ⅲ型15例,Ⅳ6例,采用一期彻底清创,放置负载敏感抗生素硫酸钙颗粒。结果所有患者均获随访12~36个月,21例患者感染均得到控制,创面一期愈合,愈合时间(12~21)天,平均(15.19±2.34)天,术后2周复查X线均发现硫酸钙开始降解,8周出现不同程度骨传导及新骨形成。所有患者均于术后8周开始部分负重行走,3个月恢复正常负重。引流管留置时间(3~8)周,平均(5.14±1.74)周。结论采用一期彻底清创填充负载抗生素硫酸钙颗粒治疗跟骨骨髓炎疗效好,感染复发率低。

Objective To study the treatment of the calcaneus osteomyelitis by one-stage debridement and compound grafting of antibiotic-impregnated calcium sulfate. Methods Twenty-one patients with calcaneus osteomyelitis were ma- naged from Jun 2012 to Dec 2014. There were 15 males and 6 females aged 33 to 35 years （mean, 43.71±6.73 years）. According to Cierny-Mader classification, there were 15 cases with stage Ⅲ and 6 cases with stage iV. The course were 1-36 months （mean, 12.67±9.62 months）. All patients were treated by one-stage debridement and filled with compound of antibiotic-impregnated calcium sulfate follow. Results All patients were followed up for 12±36 months. The wounds healed in 12 to 21 days （mean, 15.19±2.34 days）. The calcium degradation begain 2 weeks after operation. The bone conduction and the new bone formation were all started 8 weeks after operation, and all patients were partial weight-bear- ing walk, back to normal weight three months later. The drainage tube had been persisting for 3 to 8 weeks （mean, 5.14±1.74 weeks）. Conclusion A satisfactory clinical results can be gained by one-stage debridement and compound graf- ting of antibiotic-impregnated calcium sulfate in calcaneus osteomyelitis. The relapse rate of infection is low.