载万古霉素硫酸钙复合BMP-2治疗创伤性骨髓炎

Treatment of traumatic osteomyelitis with vancomycin-loaded calcium sulphate combined with bone morphogenetic protein2

目的探讨载万古霉素硫酸钙复合骨形态发生蛋白2(BMP-2)治疗创伤性骨髓炎的临床效果。方法回顾性分析2013年1月至2015年12月南京军区南京总医院收治的59例创伤性骨髓炎患者的临床资料,男27例,女32例;年龄21~62岁,平均年龄37.6岁;骨髓炎按Cierny-Mader分类:Ⅲ型37例、Ⅳ型22例;一期行内固定治疗39例、外固定支架固定20例。彻底清创后病灶内植入载万古霉素硫酸钙复合BMP-2,所有患者均改用外固定支架固定骨折断端,其中17例软组织缺损或骨缺损较大者采用带蒂转移皮瓣覆盖创面或肌筋膜瓣填塞髓腔。结果所有患者均获随访,平均随访时间13.4个月(12~23个月)。创面愈合良好,无窦道、软组织缺损及骨外露;骨折均获愈合,无感染复发,骨愈合时间5~14个月(平均7.8个月)。3例患者因骨缺损范围较大而致骨折延迟愈合,二期植入自体髂骨后骨折愈合。末次随访时按Johner-Wruhs评分标准评定疗效:优54例、良5例,优良率100%;所有患者均可负重行走,无明显疼痛及畸形。结论载万古霉素硫酸钙与BMP-2复合植入模式治疗创伤性骨髓炎,成骨可靠,安全性高,抗感染效果满意。

Objective To evaluate the curative efficacy of vancomycin-loaded calcium sulphate combined with bone morphogenetic protein2 （BMP-2） in the treatment of traumatic osteomyelifis. Methods Clinical data of 59 patients with traumatic osteomyelitis treated in Nanjing General Hospital of Nanjing Military Region from January 2013 to December 2015, were retrospectively analyzed. They were 27 males and 32 females, with an average age of 37.6 years （range from 21 to 62 years）. By the Cierny-Mader classification, the osteomyelitis was type III in 37 cases and type IV in 22 eases. The initial fractures were fixated with internal fixations in 39 cases, and with external fixators in 20 cases. After debridement, all patients were treated by vancomycin-loaded calcium sulphate combined with BMP-2, and then underwent external fixation, furthermore, 17 patients with soft tissue defect or large bone defect were treated by pedicle flap or myofascial flap. Results All patients were followed up with the average of 13.4 months （12 to 23 months）. The wounds were all sealed without sinus, soft tissue defect or bone exposure. The fracture healed in all cases without infection, with the healing time of 7.8 months （5 to 14 months）. Three patients with delayed union due to large bone defect, finally healed by autologous iliac bone grafting. At the last follow-up, according to Johner-Wruhs scoring, the results were excellent in 54 cases, good in 5 cases, with the excellent and good rate of 100%. All patients were able to walk without pain and deformity. Conelusion The composite implantation mode of vancomycin-loaded calcium sulphate and BMP-2 has satisfactory anti-infection effect, is reliable osteogenesis and high safety in treating traumatic osteomyelitis.