抗生素涂层髓内钉治疗15例胫骨干慢性骨髓炎早期疗效分析

Analysis of early curative effect of 15 cases with chronic osteomyelitis of tibial treated by antibiotic cement intramedullary nail

目的探讨抗生素涂层髓内钉治疗15例胫骨干慢性骨髓炎的早期疗效。方法选择2011年1月至2015年6月沈阳军区总医院收治的15例胫骨干慢性骨髓炎患者,应用抗生素涂层髓内钉进行治疗,评估患者末次清创手术后72 h及第1、3、6、12个月随访时血沉、C反应蛋白、中性粒细胞百分比等各项炎性指标情况;平均住院时间及最后一次复查时患肢功能恢复。结果对15例患者进行6.5~36.0个月随访,平均(19.5±3.2)个月,在术后第1、3、6、12个月及末次随访时,复查各项炎性指标,并行患侧胫骨全长正侧位X线及Enneking评分。15例胫骨干慢性骨髓炎感染相比于未行清创术时,在末次清创术72 h后各项炎性指标均明显下降。术后各个阶段复查炎性指标均在正常范围内。15例患者平均住院时间为(5.3±0.7)周。最后一次复查时患肢Enneking评分平均为(84.5%±2.6%);X线复查提示,患侧胫骨干骨连续性恢复,愈合良好,无死骨形成,愈合平均时间为(12.6±2.3)周。结论抗生素涂层髓内钉治疗胫骨干慢性骨髓炎,能够短时间内控制感染,缩短平均住院日,术后肢体功能恢复良好,值得临床推广使用。

Objective To analyze early curative effect of 15 cases with chronic osteomyelitis of tibial treated by antibiotic cement intramedullary nail.Methods A total of 15 patients with chronic osteomyelitis of tibial in our hospital from January 2011 to June 2015 were treated by antibiotic cement intramedullary nail.Postoperative infection control,average day in hospital and the limb function at the final follow-upof these patients were assessed.Results The following-up time was from 6.0 to 36.0 months[average（18.5±3.2）months].At postoperative 1,3,6,12 months and at the time of final follow-up,we reexamined the inflammatory indexes and reviewed the tibia length and lateral X-ray.Infection of all tibial chronic osteomyelitis was eliminated.The average day in hospital of these cases were（5.3±0.7）weeks.At the time of final follow-up,the average Enneking score was （78.5%±2.6%）.X-ray showed that tibia healed well and no dead bone formation was found.The average healing time was（12.6±2.3）weeks.Conclusion Antibiotic cement intramedullary nail can not only treat chronic osteomyelitis of tibial fast and efficiently and shorten the average day in hospital,but also restore functionof limb.This technology is worth developing.