依替米星PMMA骨水泥治疗开放性骨折内固定术后感染研究

Study of etimicin polymethylmethacrylat bone cement for infection after open fracture surgery

目的 对骨折内固定术后感染患者中适合病例实施依替米星聚甲基丙烯酸甲酯(PMMA)骨水泥置入治疗并观察疗效,为临床治疗提供新思路.方法 选取2009年1月-2016年12月昆山市第二人民医院收治的60例创伤致开放性骨折内固定术后局限在骨折处感染患者,依替米星PMMA骨水泥置入术者30例为治疗组,CEMEX GEN抗生素骨水泥(含庆大霉素)置入术者30例为对照组.治疗组9例自体骨移植骨水泥覆盖患者取出内固定物,清创,行一期植骨内固定联合依替米星PMMA骨水泥治疗,21例直接骨水泥堵塞患者手术取出内固定物后清创空腔置入依替米星PMMA骨水泥,6个月感染控制后,行二期自体骨植骨内固定术.对照组10例自体骨移植覆盖骨水泥患者,清创,行一期植骨内固定联合CEMEX GEN 抗生素骨水泥(含庆大霉素)治疗,20例直接骨水泥堵塞患者手术取出内固定物后清创空腔置入CEMEXGEN抗生素骨水泥(含庆大霉素),6个月感染控制后,行二期自体骨植骨内固定术.采用SPSS 19.0软件进行统计学分析处理.计量资料采用t检验,计数资料采用x2检验.结果 病原菌以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,治疗组检出37株病原菌的MIC≤2 mg/L,在依替米星安全有效的药物浓度范围内(MIC≤12 mg/L).对照组检出30株病原菌的MIC≤8 mg/L,在庆大霉素安全有效的药物浓度范围内(MIC≤12 mg/L).治疗组随访时间平均11.2个月(8～ 24个月),29例感染得到控制,对照组随访时间6～35个月,平均15.6个月,24例感染得到控制.治疗组与对照组感染控制率比较差异有统计学意义(x2=4.043,P=0.044).结论 彻底清创、大量冲洗、依替米星骨水泥置入能有效控制骨折内固定术后感染患者的感染减少复发,可在临床推广使用.

Objective Implement etimicin polymethylmethacrylat (PMMA) bone cement implantation treatment for the postoperative patients suitable with intramedullary infection after open fracture surgery,and observe the efficacy,provide new ideas for clinical treatment.Methods Selected 60 patients in Second People's Hospital of Kunshan from Jan.2009 to Dec.2016 whose infection was confined to the fracture caused by trauma after the internal fixation.Thirty cases of etimicin bone cement implantation were treated group,30 cases of CEMEX GEN antibiotic bone cement (containing gentamicin) implantation were control group.The internal fixation was taken out of 9 cases of autogenous PMMA bone graft with bone cement cover in the treatment group,debrided and taken first phase of bone grafting internal fixation combined with etimicin PMMA bone cement,21 patients with direct bone cement filling underwent surgery to remove the internal fixation devices,debridement cavity filling etimicin bone cement.Six months later when the infection was controlled,the second phase of autogenous bone graft fixation was done.Ten cases of autogenous bone graft with bone cement cover in the control group,debrided and taken first phaes of bone grafting internal fixation combined with CEMEX GEN antibiotic bone cement (containing gentamicin).Twenty patients with direct bone cement filling underwent surgery to remove the internal fixation devices,debridement cavity filling CEMEX GEN antibiotic bone cement (containing gcntamicin).Six months later when the infection was controlled,the second phase of autogenous bone graft fixation was done.SPSS 19.0 software was used for statistical analysis.The t test was used for measurement data,and the counting data were checked by chi-square.Results The pathogens were mainly staphylococcus aureus and coagulase-negative staphylococci.Thirty-seven strains of pathogenic bacteria were detected with MIC ≤ 2 mg/L in the treatment group,which was in the safe and effective drug concentration range of etimicin(MIC ≤ 12 mg/L).Thirty strains of pathogenic bacteria were detected with MIC ≤ 8 mg/L in the control group,which was in the safe and effective drug concentration range of gentamicin(MIC ≤ 12 mg/L).The average follow-up period of the treatment group was 11.2 months (range 8 to 24 months),29 cases were controlled.The average follow-up period of the control group was 15.6 months (range 6-35 months),24 cases were controlled.The difference of infection control rate between treatment group and control group was statistically significant (x2 =4.043,P =0.044).Conclusion The complete debridement,a lot of washing,and etimicin bone cement implantation can effectively control the infection after the internal fixation of fracture and reduce the recurrence,which can be used in clinical practice.