清创术联合抗骨髓炎片治疗慢性骨髓炎的效果及机制探讨

Discussion on the effect and mechanism of debridement combined with anti-myelitis tablets in the treatment of chronic osteomyelitis

目的探讨清创术联合抗骨髓炎片治疗慢性骨髓炎(COM)的临床疗效及其作用机制。方法选取2017年9月—2018年9月在武警北京市总队医院治疗的COM患者120例,随机分为对照组和研究组各60例,对照组给予常规干预措施,研究组在对照组治疗基础上联合抗骨髓炎片口服,2组疗程均为3个月。评估2组临床疗效,比较2组治疗前后白细胞计数(WBC)、血沉(ESR)、白细胞介素-1β(IL-1β)、IL-4、IL-6和IL-10水平,治疗过程中监测患者的不良反应发生情况。结果研究组患者临床有效率为86.7%(52/60),对照组为65.0%(39/60),研究组明显高于对照组(P<0.05);治疗后,2组WBC、ESR和IL-1β、IL-6水平均较治疗前显著降低(P均<0.05),研究组均显著低于对照组(P均<0.05);治疗后,2组IL-4和IL-10水平均较治疗前显著升高(P均<0.05),研究组均显著高于对照组(P均<0.05)。2组患者的不良反应发生率均较低,组间比较差异无统计学意义(P>0.05)。结论清创术联合抗骨髓炎片治疗COM患者疗效确切,其作用可能是通过调节机体免疫功能、抑制致病菌、恢复促炎与抗炎细胞因子平衡实现的。

Objective It is to investigate the clinical efficacy of debridement combined with anti-myelitis tablets on chronic osteomyelitis(COM)and to explore its mechanism.Methods A total of 120 COM patients treated in the Beijing Armed Police Corps Hospital from September 2017 to September 2018 were randomly divided into a control group and a study group,with 60 cases in each group.The control group was given conventional intervention measures,and the study group was treated with anti-myelitis tablets orally based on the treatment in the control group,the treatment course of the two groups was 3 months.The clinical efficacy of the two groups was evaluated,the levels of white blood cell count(WBC)and erythrocyte sedimentation rate(ESR),interleukin-1β(IL-1β),IL-4,IL-6 and IL-10 of the two groups before and after treatment were compared,and the occurrence of adverse reactions of the patients were monitored during treatment.Results The clinical effective rate of patients in the study group was 86.7%(52/60),and the control group was 65.0%(39/60),the study group was significantly higher than the control group(P<0.05);after treatment,the levels of WBC,ESR,IL-1βand IL-6 were significantly lower than those before treatment(all P<0.05),and the study group was significantly lower than the control group(P<0.05);after treatment,the levels of IL-4 and IL-10 in the two groups were significantly higher than those before treatment(all P<0.05),and the study group was significantly higher than the control group(P<0.05).The incidence of adverse reactions in the two groups was lower,and the difference between the groups was not statistically significant(P>0.05).Conclusion Debridement combined with anti-myelitis tablets has a definite effect on COM patients,and its action may be achieved by regulating the body’s immune function,inhibiting pathogenic bacteria,and restoring the balance of pro-inflammatory and anti-inflammatory cytokines.