抗生素骨水泥与抗生素持续灌注冲洗治疗骨折术后髓内感染的疗效比较

Clinical effectiveness of vancomycin loaded bone cement versus traditional antibiotics infusion in treatment of intramedullary infection after internal fixation

目的比较采用万古霉素骨水泥与万古霉素持续灌注冲洗治疗骨折术后髓内感染的临床疗效。方法回顾性分析2013年1月-2015年10月在本院住院的36例骨折术后髓内感染患者,其中A组20例,男14例、女6例,平均年龄(40.5±2.0)岁,接受万古霉素骨水泥治疗;B组16例,男12例、女4例,平均年龄(38.8±1.2)岁,采用万古霉素持续灌注冲洗治疗。两组患者性别、年龄、致病菌、致伤原因差异无统计学意义(P>0.05)。对两组的临床治愈率,复发率,感染指标,疼痛改善等方面进行统计学分析,比较两组治疗效果。结果所有患者均获得随访,随访时间8~12个月,平均9.4个月。A组20例全部治愈;B组16例中12例治愈,4例复发;两组治愈率差异有统计学意义(P<0.05)。两组患者血沉、C反应蛋白、白细胞、中性粒细胞比值降至正常的时间:A组分别为3 d、3 d、4 d、4 d,B组分别6 d、7 d、7 d、6 d,差异均有统计学意义(P均<0.01)。两组术前VAS评分无差异,术后24 h、72 h、1周、3周VAS评分差异有统计学意义(P均<0.05)。结论置入万古霉素骨水泥可有效控制感染,是较好的治疗骨折术后髓内感染的方法。

Objective To compare the clinical effectiveness of vancomycin loaded bone cement versus continuous vancomycin infusion in the treatment of intramedullary infection after internal fixation. Methods A total of 36 patients with intramedullary infection after internal fixation admitted to our hospital from January 2013 to October 2015 were assigned to 2 groups. Group A including 20 patients with 14 males and 6 females at an average age of （40.5±2.0） years was treated by vancomycin loaded bone cement; Group B including 16 patients within 12 males and 4 females at an average age of （38.8±1.2） years was treated by continuous vancomycin irrigation. The clinical cure rate, recurrence rate, infection indexes and pain improvement of the two groups were analyzed and compared. Results All patients were followed up for 8-12 months with an average of 9.4 months. Of them, 32 cases were cured, 4 cases recurred. All the recurred cases were in group B. The cure rates were 100% in group A versus 75% in group B with significant difference （P ＜ 0.05）. Time of ESR, CRP, WBC, NUET return to normal level were 3 d, 3 d, 4 d and 4 d in group A, respectively, and 6 d, 7 d, 7 d, 6 d in group B, respectively, with statistically significant differences between two groups （P ＜ 0.01, respectively）. There was no significant difference in VAS score between two groups before operation, and the differences were statistically significant at 24 h, 72 h, 1 week and 3 weeks after surgery （P ＜ 0.01, respectively）. Conclusion Placement of vancomycin loaded bone cement is a feasible and effective treatment for intramedullary infection after internal fixation.