万古霉素和利奈唑胺联合手术治疗耐甲氧西林金黄色葡萄球菌感染创伤性骨髓炎的疗效观察

The efficacy of vancomycin and linezolid combined with operation in the treatment of traumatic osteomyelitis infected by methicllin-resistant Staphylococcus aureus

目的观察万古霉素和利奈唑胺联合手术治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染四肢创伤性骨髄炎的临床疗效,方法回顾性分析64例MRSA感染四肢创伤性骨髓炎患者的临床资料,随机分为观察组和对照组,每组各32例:两组患者均采用一期手术治疗,在彻底清创的基础上,病灶处植入我盐酸万古霉素硫酸钙人工骨,观察组在围手术期静滴利奈唑胺葡萄糖注射液,对照组静滴盐酸万古霉素。比较两组术后的炎症指标、肾功能指标、引流管留置时间、抗生素使用时间、住院时间、不良反应发生率及骨髄炎复发率。结果术后第16d,对照组的炎症及肾功能指标与观察组比较均明显升高,差异均有统计学意义(P<0.05)。两组患者的引流管留置时间无明显差异(P>0.05);观察组的抗生素使用时间与住院时间明显低于对照组,差异有统计学意义(P<0.05);观察组的不良反应发生率为5.88%,对照组的不良反应发生率为17.65%,差异有统计意义(P<0.05)。随访期间,观察组无复发病例,对照组中有丨例患者在术后第5年出现骨髄炎复发,,结论利奈唑胺联合手术治疗MRSA感染创伤性骨髄炎更值得推荐。

Objective To observe the clinical efficacy of combined operation of vancomycin and linezolid in the treatment of traumatic osteomyelitis of the limbs infected by MRSA.Methods The clinical data of 64 patients with traumatic osteomyelitis of limbs infected by MRSA were retrospectively analyzed,and they were randomly divided into observation group and control group,with 32 cases in each group.Both groups were treated with one-stage surgery.On the basis of thorough debridement,artificial bone containing vancomycin hydrochloride calcium sulfate was implanted in the lesion.The observation group received intravenous linezolid glucose injection during the perioperative period,and the control group received intravenous injection.Drops of vancomycin hydrochloride.The postoperative inflammarion indicators,renal function indicators,drainage tube indwelling time,antibiotic use time,hospital stay,incidence of adverse reactions and recurrence rate of osteomyelitis were compared between the two groups.Results The clinical data of 64 patients with traumatic osteomyelitis oflimbs infected by MRSA were retrospectively analyzed,and they were randomly divided into observation group and control group,with 32 cases in each group.Both groups were treated with one-stage surgery.On the basis of thorough debridement,artificial bone containing vancomycin hydrochloride calcium sulfate was implanted in the lesion.The observation group received intravenous linezolid glucose injecrion during the perioperative period,and the control group received intravenous injection.Drops of vancomycin hydrochloride.The postoperative inflammation indicators,renal function indicators,drainage tube indwelling time,antibiotic use time,hospital stay,incidence of adverse reactions and recurrence rate of osteomyelitis were compared between the two groups.Conclusion Linezolid combined with surgical treatment of traumatic osteomyelitis infected by MRSA is more worthy of recommendation.