应用抗生素骨水泥植入技术治疗第一跖趾关节痛风石并骨缺损的短期疗效研究

Short⁃term Therapeutic Effect of Antibiotic Bone Cement Implantation Technology for Gouty Stones and Bone Defects in the First Metatarsophalangeal Joint

目的 研究对比痛风石病灶清理联合抗生素骨水泥植入技术与常规手术清除病灶在痛风石病人中的短期疗效。方法 回顾性分析2020年5月至2023年5月内蒙古科技大学包头医学院第一附属医院手足踝外科收治的40例第一跖趾关节痛风石伴骨缺损病人的临床资料,按照手术方法的不同分为观察组和对照组,每组20例,均为男性,年龄为22~82岁。观察组采用痛风石病灶清理联合抗生素骨水泥植入治疗,对照组则采用清理病灶的常规手术。比较两组白细胞(WBC)、C反应蛋白(CRP)、红细胞沉降率(ESR)、住院时间、换药次数、创面完全愈合时间。观察并记录病人入院时和随访3个月时美国足踝外科医师协会(AOFAS)评分、疼痛视觉模拟量表(VAS)评分和血尿酸(sUA)值。结果 病人术后随访时间3个月,观察组所有病人伤口均完全愈合,对照组20例病人中有7例伤口迁延不愈。观察组住院时间、换药次数、创面完全愈合时间、WBC、CRP、ESR、术后VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。对照组术后3个月AOFAS评分低于观察组,差异有统计学意义(P<0.05)。两组术后3个月sUA值的差异无统计学意义(P>0.05)。结论 对于第一跖趾关节痛风石并骨缺损病人,应用痛风石病灶手术清除联合抗生素骨水泥植入技术具有缩短住院时间,降低感染率,减轻病人疼痛,术后早期功能恢复快等优势,可作为严重痛风石合并骨缺损的外科治疗方法,值得推广应用。

Objective To compare the short-term efficacy of tophi debridement combined with antibiotic bone cement implantation and conventional surgical debridement in patients with tophi.Methods The clinical data of 40 patients with tophi in the first metatarsophalangeal joint with bone defect admitted to the Department of Hand,Foot and Ankle Surgery,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from May 2020 to May 2023 were retrospectively analyzed.According to different surgical methods,the patients were divided into observation group and control group,with 20 cases in each group,all males,aged 22-82 years old.The observation group was treated with tophus lesion debridement combined with antibiotic bone cement implantation,and the control group was treated with conventional surgery.The white blood cell(WBC)count,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),hospitalization time,dressing change times,and complete wound healing time were compared between the two groups.American Orthopaedic Foot and Ankle Society(AOFAS)score and visual analogue scale(VAS)score,serum uric acid(sUA)were recorded at admission and at 3rd month during the follow-up period.Results The patients were followed up for 3 months after operation.The wounds of all the patients in the observation group were completely healed,while 7 of the 20 patients in the control group had delayed wound healing.The hospitalization time,dressing change times,wound healing time,WBC count,CRP,ESR,and VAS score after operation in the observation group were significantly lower than those in the control group(P<0.05).The AOFAS score in the control group was significantly lower than that in the observation group at 3rd month after operation(P<0.05).There was no significant difference in sUA level between the two groups at 3rd month after operation(P>0.05).Conclusion For patients with tophi and bone defect in the first metatarsophalangeal joint,the application of surgical removal of tophi lesions combined with antibiotic bone cement implantation has the advantages of shortening the length of hospital stay,reducing the infection rate,relieving the pain of patients,and fastening postoperative functional recovery.It can be used as a surgical treatment for severe tophi with bone defect,and is worthy of promotion and application.