负压辅助愈合治疗系统结合载万古霉素人工骨植入治疗儿童慢性骨髓炎的疗效

Effect of vacuum assisted closure combined with antibiotic-loaded artificial bone implantation on chronic osteomyelitis in children

目的探讨负压辅助愈合治疗系统(VAC)结合载万古霉素的磷酸钙人工骨对儿童慢性骨髓炎的临床价值。方法搜集本院2017年7月至2020年6月诊断为慢性骨髓炎的21例患儿病例资料进行回顾性研究,按照治疗方法的不同分为观察组和对照组,2019年7月至2020年6月8例患儿为观察组,一期采用开窗病灶清除VAC治疗,二期采用载万古霉素磷酸钙人工骨;2017年7月至2019年7月13例患儿为对照组,采用VAC治疗。采用Wilcoxon符号秩和检验比较两组患儿的手术次数和住院时间以及术后3个月的总有效率、创面及骨愈合情况。结果观察组住院时间22.0~30.0 d,中位数26.5 d;对照组住院时间25.0~39.0 d,中位数31.0 d,两组差异有统计学意义(Z=2.524,P=0.012);观察组手术2~3次,中位数3次;对照组为2~4次,中位数3次,两组比较差异无统计学意义(Z=0.816,P=0.414);术后随访3个月,两组患儿创面及骨均愈合良好,截至随访终点,两组患儿均无复发,无病理性骨折,总有效率为100%,观察组伤口愈合美观程度优于对照组。结论负压辅助愈合治疗系统结合载万古霉素人工骨是治疗儿童慢性骨髓炎的有效方法,能有效控制感染,缩短住院时间,促进患儿术后恢复。

Objective To investigate the clinical value of vacuum assisted closure combined with vancomycin-loaded calcium phosphate artificial bone for chronic osteomyelitis in children.Methods The clinical data of 21 children diagnosed with chronic osteomyelitis in our hospital from July 2017 to June 2020 were retrospectively studied.According to the different treatment methods,they were divided into observation and control groups.From July 2019 to June 2020,8 children in the observation group were treated with focal debridement and vacuum assisted closure in phaseⅠand vancomycin-loaded calcium phosphate artificial bone in phaseⅡ.13 children in the control group were treated with VAC from July 2017 to July 2019.The Wilcoxon signed rank sum test was used to compare the number of surgeries and hospital stays and the overall efficiency,trauma,and bone healing at 3 months postoperatively in the 2 groups of children.Results In the observation group,the hospital stay ranged from 22.0 to 30.0 d,with a median of 26.5 days;in the control group,the hospital stay ranged from 25.0 to 39.0 d,with a median of 31.0 days.The difference between the two groups was statistically significant(Z=2.524,P=0.012);in the observation group,the number of surgeries was 2 to 3,with a median of 3;in the control group,it was 2 to 4,with a median of 3.The difference between the 2 groups was not statistically significant(Z=0.816,P=0.414);at the 3-month postoperative follow-up,the wounds and bones of the children in the 2 groups healed well,and by the end of the follow-up,there were no recurrences and no pathological fractures in the children in the 2 groups,with an overall efficiency of 100%,and the observation group had better aesthetic wound healing than the control group.Conclusion Vacuum assisted closure combined with vancomycin-loaded artificial bone is an effective treatment for chronic osteomyelitis in children.It can effectively control infection,shorten the hospitalization time,and promote the postoperative recovery of children.