扩创联合抗生素骨水泥在严重感染糖尿病足溃疡治疗中的应用研究

Application of debridement combined with antibiotic bone cement in the treatment of diabetic foot ulcer with severe infection

目的探讨扩创联合抗生素骨水泥在严重感染的糖尿病足溃疡(DFU)中的应用价值。方法回顾性分析自2019年6月至2020年6月入住遵义医科大学附属医院烧伤整形外科的严重感染的DFU(Wagner 3级以上,感染重度)患者19例,对其创面进行扩创联合抗生素骨水泥填充,待其感染控制后行直接缝合、植皮或皮瓣移植修复。收集扩创并联合抗生素骨水泥治疗前、治疗后7 d的白细胞计数、C反应蛋白、中性粒细胞绝对值和降钙素原等感染指标,记录患者骨水泥覆盖时间、骨水泥覆盖频次并对患者冶疗效果进行评价。记录患者随访期间再住院次数。数据行t检验、方差分析。结果19例患者的临床感染均得到有效控制。扩创联合抗生素骨水泥治疗后7 d,白细胞计数、C反应蛋白、中性粒细胞绝对值分别为(6.39±1.55)×10^(9)/L、(25.47±14.65)mg/L、5.55±1.64,明显低于治疗前[(12.97±5.27)×10^(9)/L、(126.13±42.64)mg/L、9.68±4.04],差异均有统计学意义(t=2.995、3.842、4.743,P<0.05);降钙素原指标较治疗前有所下降,但差异无统计学意义(P>0.05)。骨水泥覆盖时间10~61 d,骨水泥覆盖频次为1.4次/人。19例患者中有12例患者在抗生素骨水泥治疗后直接缝合、植皮或皮瓣移植后,创面完全愈合,达到治愈标准;2例患者要求抗生素骨水泥置入后保守换药直至创面愈合;2例患者因合并基础疾病较多,感染控制欠佳最终截肢,治疗无效;病例失随访3例。所有患者随访时间无再次入院。结论抗生素骨水泥是严重感染的DFU治疗中一种有效方法,可为创面二期修复提供创面床准备,值得推广。

Objective To discuss the application value of debridement combined with antibiotic bone cement in the treatment of severe infection of diabetic foot ulcer(DFU).Methods Nineteen patients with severe infection of DFU(Wagner grade 3 or above,severe infection)hospitalized in the Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University from June 2019 to June 2020 were retrospectively analyzed.Their wounds were expanded and filled with antibiotic bone cement.After infection control,direct sutures,skin grafting or flap transplantation were performed.White blood cell count,C-reactive protein,absolute value of neutrophil and procalcitonin were collected before and 7 days after debridement combined with antibiotic bone cement treatment,and the time,frequency of bone cement coverageand were recorded and the efficacy of treatment was evaluated.Data were compared with t test and variance analysis.Results The infection of 19 patients was controlled effectively.After 7 days of treatment,the white blood cell count,C-reactive protein,absolute value of neutrophil and procalcitonin were(6.39±1.55)×10^(9)/L,(25.47±14.65)mg/L,5.55±1.64,which were significantly lower than before treatmen[(12.97±5.27)×10^(9)/L,(126.13±42.64)mg/L,(9.68±4.04)],the differences were statistically significant(t=2.995,3.842,4.743;P<0.05);the level of procalcitonin decrease compared with before treatment,but the difference was not statistically significant(P>0.05).The covering time of bone cement were 10-61 days,and the covering frequency of bone cement was 1.4 times per person.Among the 19 cases,12 cases were cured by direct suture,skin graft or skin flap transplantation after antibiotic bone cement filling,2 cases were changed dressing until cured after bone cement treatment,amputation in 2 cases and loss of follow-up in 3 cases.The patient was not hospitalized again during the follow-up period.Conclusion Antibiotic bone cement is an effective method in the treatment of DFU with severe infection,which could provide wound bed preparation for the following wound repair.