Ⅰ期清创联合抗生素骨水泥珠链填塞治疗骨折后慢性感染

Phase I debridement combined with antibiotic bone cement bead chain packing for chronic infection after fracture

目的探讨Ⅰ期清创联合抗生素骨水泥珠链填塞治疗慢性骨感染的临床疗效。方法采用回顾性病例系列研究分析2015年2月-2017年6月华中科技大学同济医学院附属协和医院收治的50例慢性骨感染患者临床资料，其中男38例，女12例；年龄28—70岁[（48．4±5．1）岁]。感染部位：胫骨36例，股骨7例，趾骨3例，跟骨2例，脊柱2例。骨折内固定术后感染42例，单纯骨折后感染8例。患者均采用Ⅰ期清创联合抗生素骨水泥珠链填塞术。记录术前及术后1，4，7d患者红细胞沉降率（ESR）和C-反应蛋白（CRP）的变化、感染控制率、清创手术次数、植骨后骨性愈合时间及感染复发率。结果患者均获随访6～22个月[（12．4±2．9）个月]。ESR和CRP术后1，4，7d与术前[（41．2±5．3）mm／h、（83．2±9．3）mg／L]比较分别为（37．1±4．8）mm／h、（32．5±3．1）mm／h、（22．3±1．9）mm／h和（71．1±4．6）mg／L、（66．5±3．1）mg／L、（39．3±1．9）mg／L（P〈0．05）。感染控制率为94％（47／50）。清创次数为2～5次[（2．2±0．3）次]。植骨后骨性愈合时间为14—30周[（24．6±6．7）周]。感染复发率为2％（1／47）。结论Ⅰ期清创联合抗生素骨水泥珠链填塞治疗慢性骨感染，感染控制率高，植骨后骨性愈合满意，术后感染复发率低，是一种理想的治疗慢性骨感染的手段。

Objective To investigate the clinical effect of phase I debridement combined with antibiotic bone cement bead chain packing for chronic infection after fracture. Methods A retrospective case series study was carried out to analyze the clinical data of 50 patients with chronic bone infection admitted to Wuhan Union Hospital from February 2015 to June 2017. There were 38 males and 12 females, aged 28-70 years [ （48. 4 ± 5. 1 ）years]. In terms of the infection site, there were 36 patients at the humerus, seven at the femur, three at the phalanges, two at the calcaneus, and two at the spine. A total of 42 infection patients were reported after internal fixation, and eight infection patients were reported after fracture. All patients were treated with phase I debridement combined with antibiotic bone cement bead chain packing. The changes of erythroeyte sedimentation rate （ESR） and C-reactive protein （CRP） before operation and 1, 4 and 7 days after operation, infection control rate, number of debridement operations, bone healing time after bone grafting, and infection recurrence rate were recorded. Results The patients were followed up for 6-22 months [ （ 12.4 ± 2. 9 ） months ]. At postoperative 1, 4 and 7 days, the preoperative ESR [ （41.2 ± 5.3 ） mm/h ] and preoperative CRP [ （ 83.2 ± 9.3 ） mg/L J were decreased to （ 37.1 ± 4.8 ） ram/h, （32.5 ±3.1 ） mm/h, （22.3 ± 1.9） mm /h and （71.1 ±4.6）mg/L,（66.5 ± 3. 1 ） mg/L, （39.3 ± 1.9） mg/L, respectively （P 〈 0.05 ）. The infection control rate was 94% （47/50）, and the number of debridement operations was 2-5 [ （2.2 ＋0.3） ]. The bone healing time was 14-30 weeks [ （24.6 ± 6.7 ） weeks ] , and the infection recurrence rate was 2% （1/47）. Conclusion Phase I debridement combined with antibiotic bone cement bead chain packing is an ideal method in treating chronic bone infection, with high infection control rate, low recurrence rate, and satisfactory bone union.