载抗生素骨水泥治疗糖尿病足坏死性筋膜炎致小腿筋膜室综合征

Antibiotic-loaded bone cement in treatment of calf compartment syndrome caused by diabetic foot necrotizing fasciitis

背景:目前坏死性筋膜炎的治疗方法大多是充分彻底清创后使用负压封闭吸引,该方法需要反复多次清创才能彻底清除坏死感染组织,给患者造成严重的身体负担和经济负担。目的:介绍一种临床少见的病例——糖尿病足坏死性筋膜炎导致的小腿筋膜室综合征,总结使用载抗生素骨水泥进行治疗与综合管理的临床经验。方法:选择2017年8月至2020年8月苏州大学附属无锡九院收治的糖尿病性坏死性筋膜炎导致的小腿筋膜室综合征患者6例,男5例,女1例,平均年龄54岁,围术期整体把控患者全身情况并进行全身营养支撑治疗,所有患者均一期行彻底清创+载抗生素骨水泥填塞+负压封闭引流以控制感染、二期取出骨水泥并行创面修复治疗。出院后随访时观察患者创面愈合情况及有无红肿渗液发生。结果与结论:①4例患者经过2次载抗生素骨水泥填塞后创面新鲜,诱导膜形成良好,1例经过3次抗生素骨水泥填塞后诱导膜形成良好,这5例患者二期经过植皮手术后创面均愈合良好;1例患者急诊手术时因术中血压难以维持且小腿4个间室均出现感染,急诊行膝上截肢,同时残端创面放置载抗生素骨水泥,二期骨水泥取出后创面直接闭合,创面一期愈合;②6例患者出院后随访6-24个月,末次随访时,6例患者创面均愈合良好、无红肿渗液等症状,患者生活质量明显改善,均对疗效表示满意;③对于临床高度怀疑糖尿病足坏死性筋膜炎时应警惕小腿筋膜室综合征的发生,早期诊断、及时切开减压至关重要,应用载抗生素骨水泥治疗糖尿病性坏死性筋膜炎导致的小腿筋膜室综合征短期疗效较好。

BACKGROUND:At present,the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement.This method requires repeated debridement to completely remove necrotic infected tissue,causing serious physical and economic burdens to patients.OBJECTIVE:To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis,and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management.METHODS:A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9^(th)Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected,including 5 males and 1 female with an average age of 54 years.During the perioperative period,the patients’general condition was evaluated and systemic nutritional support treatment was given.In the first stage,all patients received complete debridement to control infection,antibiotic-loaded bone cement packing,and negative pressure sealed drainage.In the second stage,bone cement was removed and wound repair was performed.The wound healing,as well as the occurrence of redness,swelling,and exudation was observed during the follow-up.RESULTS AND CONCLUSION:(1)The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing,and the membrane formation was good,and one patient was good after three times of antibiotic-loaded bone cement packing,and the wounds of all five patients healed well after the second stage of skin grafting.Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg,a patient underwent emergency knee amputation.Meanwhile,the stump wound was placed with antibiotic-loaded bone cement.The wound was closed directly after the secondary bone cement was removed,and the wound healed in the first stage.(2)The six patients were followed up for 6-24 months after discharge.At the last follow-up,all six patients had good wound healing and no symptoms such as redness,swelling,and exudation.The quality of life of the patients was significantly improved,and all of them were satisfied with the curative effect.(3)The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected.Early diagnosis and timely incision decompression are of great importance.Besides,the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.