胫骨骨髓炎病灶彻底清除后使用与不使用抗生素骨水泥的疗效比较

Treatment of tibial osteomyelitis with versus without antibiotic cement after radical debridement

目的比较胫骨骨髓炎病灶彻底清除后使用与不使用抗生素骨水泥的疗效。方法回顾性分析从2010年1月至2015年6月深圳大学附属第一医院创伤骨科收治并完整随访的68例感染病灶彻底清除的胫骨骨髓炎患者资料,均为局部Cierny-MaderⅣ型。其中彻底清创后使用抗生素骨水泥填充死腔的患者(骨水泥组)32例,未使用抗生素骨水泥的患者(非骨水泥组)36例,两组患者均由同一组医生进行手术,术后使用骨搬运技术填充感染骨段截除后的骨缺损。随访记录并比较两组患者Paley的评分系统评定的骨骼和肢体的功能评分、外固定指数(EFI)、感染复发率、总住院费用及其他并发症情况。结果骨水泥组和非骨水泥组患者的一般资料比较差异均无统计学意义(P>0.05),具有可比性。骨水泥组和非骨水泥组随访时间分别为(71.2±8.9)、(71.6±9.7)个月,差异无统计学意义(P>0.05)。采用Paley的评分系统疗效:骨水泥组和非骨水泥组骨骼评分优良率均为100%(32/32、36/36),肢体功能评分优良率分别为93.8%(30/32)、94.4%(34/36),两组间评分差异均无统计学意义(P>0.05)。骨水泥组和非骨水泥组EFI分别为(49.0±10.5)、(49.5±11.4)d/cm,差异无统计学意义(P>0.05)。末次随访时骨水泥组和非骨水泥组感染复发率分别为3.12%(1/32)、2.78%(1/36),差异无统计学意义(P>0.05)。骨水泥组和非骨水泥组总住院费用分别为(70944.1±1135.5)、(55205.2±897.3)元,差异有统计学意义(P<0.05)。两组患者均无存在后遗症的严重并发症的发生。结论对于局部的Cierny-MaderⅣ型的胫骨骨髓炎患者,若手术彻底清楚感染病灶,使用抗生素骨水泥填充死腔并非必要。

Objective To compare the therapeutic outcomes between use of antibiotic cement versus non-use of antibiotic cement in the treatment of tibial osteomyelitis after radical debridement.Methods A retrospective analysis was made of the 68 patients with local tibial osteomyelitis of Cierny-Mader TypeⅣwho had been treated at Department of Orthopaedic Trauma,The Second People’s Hospital of Shenzhen from January 2010 to June 2015.The dead space was filled with antibiotic-impregnated bone cement beans after radical debridement of the infected bone in 32 of them(cement group)but was not in 36 of them(no-cement group).The operations for both groups were performed by the same surgical team who filled the bone defects after excision of infected bone using Ilizarov bone transport.The 2 groups were compared in terms of Paley functional scores of bone and limb,external fixation index(EFI),infection recurrence rate,total hospital costs and other complications.Results The 2 groups were comparable because there was no significant difference between them in the preoperative general data(P>0.05).The cement group was followed up for(71.2±8.9)months and the no-cement group for(71.6±9.7)months,showing no significant difference(P>0.05).By the Paley functional scores,the good to excellent rate for bone was 100%for both groups(32/32 versus 36/36)while the good to excellent rate for limb was 93.8%(30/32)for the cement group and 94.4%(34/36)for the no-cement group,showing no significant differences between them(P>0.05).The EFI was(49.0±10.5)d/cm for the cement group and(49.5±11.4)d/cm for the no-cement group,showing no significant differences between them(P>0.05).The infection recurrence rate at the final follow-up was 3.12%(1/32)for the cement group and 2.78%(1/36)for the no-cement group,showing no significant differences between them(P>0.05).The total hospital cost was(70,944.1±1,135.5)Yuan RMB for the cement group and(55,205.2±897.3)Yuan RMB for the no-cement group,showing a significant difference(P<0.05).No serious complications with sequelae were found in either of the 2 groups.Conclusion In the treatment of local tibial osteomyelitis of Cierny-Mader TypeⅣ,it is not necessary to fill the dead space with antibiotic cement when radical debridement is achieved.