扩大清创结合BAM骨诱导人工骨修复治疗Cierny-MaderⅣ型骨髓炎的临床效果及安全性分析

Clinical efficacy and safety of extended debridement combined with BAM bone-induced artificial bone repair in treating Cierny-Mader type IV osteomyelitis

目的探究扩大清创结合BAM骨诱导人工骨修复治疗Cierny-MaderⅣ型骨髓炎临床效果及安全性。方法回顾性选取2021年1月至2022年12月于四川省骨科医院骨病科就诊且接受同种异体骨混合自体骨治疗的106例Cierny-MaderⅣ型骨髓炎患者为研究对象,将其中联合BAM骨诱导人工骨混合自体骨修复治疗的54例患者纳入观察组;单纯同种异体骨混合自体骨修复治疗的52例患者纳入对照组。比较两组患者临床相关指标(骨性愈合时间、骨折愈合时间),于术后1年根据Johner-Wruh胫骨干骨折评定标准比较两组患者临床疗效,比较术前及术后1年两组患者炎症因子[白细胞计数(white blood cell count,WBC)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(c-reactive protein,CRP)、降钙素原]、肢体功能[美国足踝外科协会后足评分量表(american orthopaedic foot and ankle society ankle-hindfoot scale,AOFAS-AH)]、骨愈合程度,计数资料组间率的比较采用χ^(2)检验,符合正态分布的计量资料组间比较采用独立样本t检验。结果术后1年,观察组患者临床愈合时间[骨性愈合时间(21.19±2.16)周、骨折愈合时间(11.35±1.01)周]、炎症因子水平[WBC(6.15±0.73)×10^(9)/L、ESR(9.10±1.05)mm/h、CRP(8.09±1.11)mg/L、降钙素原(0.05±0.01)μg/L]均低于对照组[骨性愈合时间(24.32±2.39)周、骨折愈合时间(12.29±1.27)周]、[WBC(7.86±0.89)×10^(9)/L、ESR(10.10±1.32)mm/h、CRP(9.26±1.23)mg/L、降钙素原(0.08±0.01)μg/L],差异均有统计学意义(t值分别为7.08、4.23、10.83、4.33、5.15、15.44,均P<0.001)。观察组患者临床有效率[85.19%(46/54)]、AOFAS-AH评分[(84.83±12.17)分]、骨愈合率[94.44%(51/54)高于对照组67.31%(35/52)、(79.17±11.25)分、80.77%,(42/52)],差异均有统计学意义(统计量值分别为χ^(2)=4.70、t=2.48、χ^(2)=4.60,P值分别为0.030、0.015、0.032)。结论扩大清创联合BAM骨诱导人工骨修复技术能够有效促进Cierny-MaderⅣ型骨髓炎患者骨部组织愈合,减轻其炎症反应,提高其肢体功能,临床疗效良好,具有较高安全性。

ObjectiveTo explore the clinical effect and safety of extended debridement combined with BAM bone-induced artificial bone repair in the treatment of Cierny-Mader type IV osteomyelitis.MethodsFrom January 2021 to December 2022,106 patients with Cierny-Mader type IV osteomyelitis who were treated with allogeneic bone mixed with autologous bone in department of orthopedics of Sichuan Orthopedic Hospital were retrospectively selected as the study subjects.Among them,54 patients who were combined with BAM bone-induced artificial bone mixed with autologous bone repair were included in observation group,and 52 patients who only received allogeneic bone mixed with autologous bone repair were enrolled as control group.The clinical related indicators(bone healing time,fracture healing time),clinical efficacy(Johner-Wruh tibial shaft fracture evaluation standard)at 1 year after surgery,inflammatory factors(white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),procalcitonin),limb function(American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS-AH))and bone healing degree before surgery and at 1 year after surgery were compared between both groups.Chi-square test was used to compare the enumeration data between groups,and the independent sample t test was performed to compare the measurement data with normal distribution between groups.ResultsAt 1 year after surgery,the clinical healing indicators of bone healing time and fracture healing time and inflammatory factors such as WBC,ESR,CRP and procalcitonin with(21.19±2.16)weeks,(11.35±1.01)weeks,(6.15±0.73)×10^(9)/L,(9.10±1.05)mm/h,(8.09±1.11)mg/L and(0.05±0.01)μg/L in observation group were significantly shorter or lower than(24.32±2.39)weeks,(12.29±1.27)weeks,(7.86±0.89)×10^(9)/L,(10.10±1.32)mm/h,(9.26±1.23)mg/L and(0.08±0.01)μg/L in control group,and the differences were statistically significant(t values were 7.08,4.23,10.83,4.33,5.15,and 15.44,respectively;all P<0.001).The clinical effective rate(85.19%(46/54)),AOFAS-AH score((84.83±12.17)points)and bone healing probability(94.44%(51/54))were higher than(67.31%(35/52)),(79.17±11.25)points and 80.77%(42/52)in control group,with statistically significant differences(statistical values wereχ^(2)=4.70,t=2.48,andχ^(2)=4.60,respectively;P values were 0.030,0.015,and 0.032,respectively).ConclusionExpanded debridement combined with BAM bone-induced artificial bone repair can effectively promote the bone tissue healing in patients with Cierny-Mader type IV osteomyelitis,relieve the inflammatory response,and improve the limb function,and it has good clinical efficacy and high safety.