抗生素骨水泥联合其他综合干预措施治疗糖尿病足骨髓炎

Antibiotic bone cement combined with other comprehensive interventions in the treatment of diabetic foot osteomyelitis

目的 评估万古霉素骨水泥联合其他干预措施治疗糖尿病足骨髓炎(Diabetic foot osteomyelitis,DFO)的疗效。方法 回顾性分析93例(112侧)糖尿病足骨髓炎患者,均接受万古霉素骨水泥联合其他干预措施治疗。末次随访时评估口服和静脉抗生素使用时间、住院时间、溃疡愈合时间、复发率、踝关节以上截肢率。对糖尿病足患者进行足溃疡深层创面分泌物细菌培养。足部功能恢复情况应用Maryland足功能评分标准进行评估。结果 成功随访87例患者(105侧),平均随访时间14个月,均愈合良好,糖尿病足治愈。口服和静脉注射抗生素的平均使用时间分别为(12.2±1.5) d和(10.8±2.5) d,平均住院时间(14.0±2.7) d,溃疡愈合时间(37.8±6.3) d。21例患者(21侧)足溃疡复发后再次住院,复发率为20.0%(21/105)。本组中无患者需在脚踝以上截肢。从足溃疡深部创面分泌物中共培养了144株致病菌。末次随访显示,31侧为优秀,45侧良好,26侧一般,3侧不合格,总体优良率为72%。结论 抗生素骨水泥联合其他综合干预治疗DFO效果良好,值得在临床推广应用。

Objective To evaluate the efficacy of vancomycin bone cement combined with other comprehensive interventions in the treatment of diabetic foot osteomyelitis(DFO). Methods A retrospective analysis of 93 patients with DFO(112 affected feet) who received vancomycin bone cement combined with other interventions was performed. Duration of oral and intravenous antibiotic use, length of hospital stay, ulcer healing time, recurrence rates, and amputation rates above the ankle were assessed at the last follow-up. Bacterial culture of secretion from deep wound surface of foot ulcer was conducted. Recovery of foot function was assessed using the Maryland standard. Results Eighty-seven patients with 105involved feet were followed up successfully over an average period of 14 months. All wounds exhibited good union on follow up, and DFO was cured. The average durations of oral and intravenous antibiotic administrations were(12.2 ±1.5) and(10.8±2.5) days, respectively. The average duration of hospitalization was 14.0 ±2.7 days and the healing time of the ulcers was(37.8±6.3) days. Twenty-one patients(21 feet) were re-hospitalized after recurrence of foot ulcers, with a recurrence rate of 20%(21/105). No patients required amputation above the ankle. One hundred and forty-four pathogenic bacteria were co-cultured from the secretions of deep wounds from foot ulcers. According to the Maryland criteria, 31, 45, 26, and 3 feet were rated as excellent, good, fair, and failure, respectively. Overall, 72% were rated as excellent-good. Conclusion Antibiotic bone cement combined with other comprehensive interventions is effective and comprehensive in the treatment of DFO, which is worthy of clinical application.