负压封闭引流联合万古霉素珠链植入治疗慢性骨髓炎疗效及对相关血清指标的影响

The curative effect of vacuum sealing drainage combined with vancomycin bead chain implantation in the treatment of chronic osteomyelitis and its influences on serum relative indexes

目的探讨负压封闭引流联合万古霉素治疗慢性骨髓炎疗效及对血清炎症因子、转化生长因子(TGF-β1)、Smad 3水平的影响。方法82例慢性骨髓炎患者,采用随机数字表法分为观察组及对照组各41例。对照组采用常规引流及抗生素灌洗治疗,观察组采用封闭负压引流联合万古霉素珠链植入治疗,比较两组围手术期恢复指标、疼痛视觉模拟评分(VAS)及血清C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、TGF-β1、Smad3等指标水平,随访并比较术后复发情况。结果观察组骨吸收时间、骨缺损愈合时间少于对照组,治疗后1、3月VAS评分低于对照组(P<0.05),两组治疗后6月VAS评分比较,差异无统计学意义(P>0.05)。治疗后1月观察组血清CRP、TNF-α、IL-6水平低于对照组,TGF-β1、Smad3水平高于对照组(P<0.05)。两组治疗后3、6月复发率比较,差异无统计学意义(P>0.05),治疗后12月观察组复发率低于对照组(P<0.05)。结论负压封闭引流联合万古霉素珠链植入可缩短慢性骨髓炎恢复时间,提高治疗效果,其机制可能与降低机体炎症反应,促进成骨效应相关。

Objective To explore the curative effect of vacuum sealing drainage(VSD)combined with vancomycin bead chain implantation in the treatment of chronic osteomyelitis and its influences on levels of serum inflammatory factors,transforming growth factorβ1(TGF-β1)and Smad3.Methods Eighty-two patients with chronic osteomyelitis admitted to our hospital were divided into observation or control group by random number table method,41 in each group.The control group was treated with routine drainage and antibiotic lavage while the observation group was treated with VSD combined with vancomycin bead chain implantation.The perioperative recovery indexes,score of pain analogue scale(VAS),levels of serum C-reaction protein(CRP),tumor necrosis factor(TNF-α),interleukin-6(IL-6),TGF-β1 and Smad3 were compared between the two groups.The follow-up was conducted and postoperative recurrence was compared.Results The bone resorption time and bone defect healing time in the observation group were significantly shorter than those in the control group(P<0.05).After 1 month and 3 months of treatment,VAS score in the observation group were significantly lower than that in the control group(P<0.05).However,after 6 months of treatment,there was no significant difference in VAS score between the two groups(P>0.05).After 1 month of treatment,levels of serum CRP,TNF-αand IL-6 in the observation group were significantly lower while TGF-β1and Smad3 were higher than those in the control group(P<0.05).After 3 and 6 months of treatment,there was no significant difference in recurrence rate between the two groups(P>0.05).After 12 months of treatment,recurrence rate of the observation group was significantly lower than that of the control group(P<0.05).Conclusion VSD combined with vancomycin bead chain implantation can shorten the recovery time of chronic osteomyelitis,and improve the curative effect.The mechanism may be related to reduction of body inflammatory response and promotion of osteogenic effect.