硫酸钙负载万古霉素治疗下肢慢性骨髓炎的临床分析

Clinical Effect of Vancomycin-loaded Calcium Sulfate in the Treatment of Lower Limb Chronic Osteomyelitis

目的探讨负载万古霉素的硫酸钙治疗成人下肢慢性骨髓炎的方法及临床效果。方法回顾性分析2017年3月—2018年12月医院收治的成人下肢慢性骨髓炎患者共14例,其中男10例,女4例;年龄18~73岁,平均37.8岁。采用彻底清创慢性骨髓炎病灶,创腔内植入负载万古霉素的硫酸钙,对骨质破坏严重的胫骨结合外固定支架保护治疗,涉及大段骨缺损者结合环形外固定架骨搬运技术治疗,治疗期间全身应用标准浓度的敏感抗生素。术后观察伤口愈合情况、实验室感染指标结果、感染复发及断端对接阻塞等情况。结果14例患者均获得随访,9例伤口呈甲级愈合,5例出现伤口延迟愈合,主要为伤口的无菌性渗出并发症,经换药后伤口愈合,复查炎性指标均恢复正常或显著下降。随访复查X光片见骨缺损处填充的负载万古霉素的硫酸钙颗粒逐渐被吸收,新骨逐渐长入,最终骨性愈合,患者恢复行走功能。结论负载万古霉素的硫酸钙治疗慢性骨髓炎可以在控制感染的同时重建骨缺损,减少感染复发率和对接障碍,是治疗慢性骨髓炎比较理想的方法。

Objective To investigate the clinical effect and surgical method by using the vancomycin-loaded calcium sulfate for the treatment of adults lower limb chronic osteomyelitis.Methods A retrospective case series study was made on 14 patients with chronic osteomyelitis treated from March 2017 to December 2018.There were 10 males and 4 females,with a mean age of 37.8 years(range18-73 years).After thorough debridement and removal of dead bone and infection tissue,vancomycin-loaded calcium sulfate was put into the cavities,for some obvious bone destruction on fibula or massive bone defects,by using external fixation to acquire stabilization or use circular external fixator to extend the bone.In the treatment time,sensitive antibiotics were added to patients.Postoperative wound healing,laboratory infection index,infection recurrence and docking obstruction were observed.Results All the patients were followed up.The wounds of 9 cases got healed with grade A,5 case got delayed and none of them had any infections.Patient's X-ray films showed that calcium sulphate was absorbed and a lot of callus occurred,followed bybone union finally and the patients walking function restored.Conclusion The vancomycin-loaded calcium sulfate is an ideal method for the treatment of lower limb chronic osteomyelitis,for it not only controls bone infection effectively and rebuilt bone defect,but also decreases infection recurrence and docking obstruction.