负压辅助闭合技术联合载抗生素硫酸钙治疗创伤后慢性骨髓炎的效果

Clinical effect of vacuum assisted closure and antibiotic-loaded calcium sulfate on posttraumatic chronic osteomyelitis

目的探讨负压辅助闭合(vacuum assisted closure,VAC)技术联合载抗生素硫酸钙治疗四肢创伤后慢性骨髓炎的临床疗效。方法回顾性分析2018年1月~2019年7月中南大学湘雅二医院骨科诊治的31例四肢创伤后慢性骨髓炎患者,根据治疗方法分为两组。研究组16例,采用Ⅰ期彻底清创、VAC覆盖骨缺损处及创面,Ⅰ期术后5~7 d植入载万古霉素和庆大霉素硫酸钙治疗;对照组15例,采用Ⅰ期彻底清创、植入载万古霉素和庆大霉素硫酸钙治疗。比较两组术后感染清除率、感染复发率、骨折愈合时间及治疗前后C反应蛋白(C-reactive protein,CRP)水平和红细胞沉降率(erythrocyte sedimentation rate,ESR)。结果平均随访14(6~24)个月,研究组的感染清除率为93.7%(15/16),高于对照组60%(9/15),差异有统计学意义(P=0.037)。研究组术后6个月感染复发率0%(0/16),与对照组6.7%(1/15)比较无显著性差异(P=0.484)。治疗后2个月,研究组CRP为(12.25±3.28)mg/L,显著低于对照组(17.27±4.65)mg/L(P=0.002);研究组ESR为(18.31±4.19)mm/h,显著低于对照组(26.27±5.16)mm/h(P<0.001)。研究组的平均骨折愈合时间为(10.53±2.42)个月,显著短于对照组的(12.29±1.89)个月(P=0.039)。结论与单独载抗生素硫酸钙相比,VAC联合载抗生素硫酸钙治疗四肢创伤后慢性骨髓炎更有效,能提高感染清除率,降低术后炎性因子及血沉水平。

Objective To investigate efficacy of the combined use of vacuum assisted closure(VAC)and antibiotic-loaded calcium sulfate on posttraumatic chronic osteomyelitis.Methods A total of 31 patients with posttraumatic chronic osteomyelitis of limbs admitted in the Department of Orthopaedic of the Second Xiangya Hospital,Central South University from January 2018 to July 2019 were enrolled.In the control group,fifteen patients received a one-stage operation with the rigid debridement and filling the space with vancomycin/gentamicin-loaded calcium sulfate during the same period of surgery.In the study group,sixteen patients underwent a two-stage surgery,with a rigid debridement and VAC for the first stage,and implantation of vancomycin/gentamicin-loaded calcium sulfate 5 to 7 days after VAC for the second stage.The infection clearance rate,osteomyelitis recurrence rate and fracture healing time were compared between the two groups.Furthermore,the level of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were assessed and compared before and two months after the operation.Results The average follow-up time was 14 months(ranged 6 to 24 months).The infection clearance rate in the study group(93.7%)was significantly higher than that in the control group(60%),P=0.037.There was no recurrence in the study group,while one patient from the control group suffered a recurrence of infection 6 months after operation(P=0.484).Furthermore,the average length of the fracture healing period of the study group was(10.53±2.42)months,which was significantly shorter than(12.29±1.89)months of the control group(P=0.039).Two months after the operation,a significantly greater reduction of CRP and ESR was found in the study group.Conclusion The combined use of VAC and antibiotic-loaded calcium sulfate is more effective comparing with one-stage debridement and implantation of vancomycin/gentamicin-loaded calcium sulfate for the treatment of posttraumatic chronic osteomyelitis of limbs.