喀什地区单中心慢性骨髓炎的临床特征分析及疗效评价

Analysis of clinical characteristics and treatment of extremity of chronic osteomyelitis in Kashgar Area

目的回顾性分析喀什地区单中心四肢慢性骨髓炎的临床特征及不同治疗方式的临床疗效。方法回顾性分析303例于2010年10月1日至2019年10月30日就诊于在喀什地区第一人民医院骨科的诊断明确的四肢慢性骨髓炎患者的临床资料。试验数据分析采用SPSS 13.0统计学软件;对于连续型变量,首先采用Kolmogorov-Smirnov进行正态分布检验,对于符合正态分布的数据采用均数±标准差的形式表示,不符合正态分布的数据采用中位数和四分位间距的形式表示;对于符合正态分布的数据,2组或2组以上组间均数比较分别采用独立样本t检验和单个样本均数的方差分析,而对于不符合正态分布的数据,则分别采用Mann-Whitney U检验和Kruskal-Wallis H检验;而对于二分类变量则采用百分率的形式表示,各组之间的率的比较采用卡方检验;当P≤0.05时认为差异具有统计学意义。结果男215例,女88例,性别比例为2.4∶1。首次诊断的中位年龄为34.2岁。外伤性骨髓炎(167例,54.9%)是最常见的类型,主要由开放性损伤(67例,22%)和高处坠落伤(47例,28.1%)引起。以胫骨(119例,占39%)、股骨(91例,占29.9%)、足趾骨(35例,占11.5%)、跟骨(15例,占4.9%)为主。术中培养阳性率为84.58%(214/253),其中73.5%(186/253)为单一菌感染。金黄色葡萄球菌(118例,63.4%)是单一微生物感染最常见的细菌,其次是大肠埃希菌(19例,10.2%)和铜绿假单胞菌(15例,8.1%)。术前血清白细胞(WBC)、血沉(ESR)、C-反应蛋白(CRP)、降钙素原(PCT)、超敏C-反应蛋白阳性率分别为20.7%、69.6%、62%、62%和59.3%。最常用的静脉抗生素是头孢菌素类。总治愈率79.2%,总截肢率10.2%。结论喀什地区四肢慢性骨髓炎多为开放性损伤和高处坠落伤所致,男性多见,胫骨多见。金黄色葡萄球菌是最常见的致病菌。术前血沉和C-反应蛋白水平升高可能有助于该疾病的诊断。大部分患者经过合理的治疗后,临床疗效良好。

Objective To retrospectively analyze the clinical characteristics of chronic osteomyelitis of extremities in Kashgar area and the clinical efficacy of different treatment methods. Methods The clinical data of 303 patients with chronic osteomyelitis of extremities diagnosed in the Department of Orthopedics of the First People’s Hospital of Kashgar from October 1, 2010 to October 30, 2019 were retrospectively analyzed. SPSS was used to analyze the test data 13.0 statistical software;for continuous variables, Kolmogorov Smirnov was used to test the normal distribution, the data conforming to the normal distribution was expressed in the form of mean ±standard deviation, and the data not conforming to the normal distribution was expressed in the form of median and interquartile interval;for data conforming to the normal distribution, the mean comparison between two or more groups was performed in the form of single factor analysis For the data that do not conform to the normal distribution, Mann Whitney U test and Kruskal Wallis h test are used respectively;for the binary variables, percentages are used, and chi square test is used to compare the rates among groups;when P≤0.05, the difference is considered to be statistically significant. Results The ratio of male to female was 1.88. The median age of first diagnosis was 34.2 years.Traumatic osteomyelitis(167 cases, 54.9%)was the most common type, mainly caused by open injury(67 cases, 22%)and falling injury(47 cases, 28.1%). Tibia(119 cases, accounting for 39%), femur(91 cases, accounting for 29.9%), toe bone(35 cases, accounting for 11.5%), calcaneus(15 cases, accounting for 4.9%). The positive rate of intraoperative culture was 84.58%(214/253), of which 73.5%(186/253)was single bacterial infection. Staphylococcus aureus(118 cases, 63.4%)was the most common bacteria for single microbial infection, followed by Escherichia coli(19 cases, 10.2%)and Pseudomonas aeruginosa(15 cases, 8.1%). The positive rates of WBC,ESR, CRP, PCT and hs CRP were 20.7%, 69.6%, 62%, 62% and 59.3%, respectively. The most commonly used intravenous antibiotics are cephalosporins. The total cure rate was 79.2%, and the total amputation rate was 10.2%. Conclusions Chronic osteomyelitis of extremities in Kashi area is mostly caused by open injury and falling injury, which is more common in men and tibia. Staphylococcus aureus is the most common pathogenic bacteria. The increase of ESR and CRP level before operation may be helpful for the diagnosis of the disease. Most patients after reasonable treatment, clinical curative effect is good.