摘要
[目的]探讨局部应用抗生素缓释系统治疗创伤后及内固定术后骨感染的临床疗效。[方法]自2009年5月∽2013年9月采用抗生素缓释系统局部应用治疗创伤后骨感染32例,男14例,女18例,平均年龄46岁（15∽61岁）。骨折内固定术后骨感染20例,胫骨开放骨折继发感染4例,外伤性骨髓炎8例。解剖部位：股骨4例,胫骨16例,肱骨2例,跟骨8例,跖骨2例。左16例,右16例。手术方法：首先彻底清创病灶,然后将自行制备负载抗生素PMMA骨水泥链珠或硫酸钙人工骨置入感染灶,常规放置引流,术后48∽72 h内拔除。以感染清除率、骨愈合率、愈合时间和再手术率作为疗效评价指标。[结果]平均随访28个月（12∽47个月）。25例骨感染Ⅰ期痊愈,Ⅰ期感染清除率（25/32）78.1%,剩余7例中5例再手术后愈合,再手术率21.9%,Ⅱ期感染清除率（30/32）93.7%。30例骨折/骨腔愈合,2例骨折骨腔未完全愈合,愈合率93.7%。骨折平均愈合时间4.2个月（3∽6个月）,骨腔平均愈合时间5.2个月（2∽8个月）。硫酸钙人工骨吸收平均8周（4周∽7个月）。[结论]清创后局部应用载抗生素缓释系统治疗创伤后及骨折内固定术后骨感染治愈率和骨折/骨腔愈合率高,而负载抗生素的硫酸钙人工骨具有抗感染和骨修复作用等,是用于治疗上述骨感染的理想方法。
[Objective]To evaluate the effectiveness of antibiotic- impregnated drug delivery systems locally used after debridement in treating patients with post- traumatic and implant- related bone infection. [Method]From May 2009 to September 2013,32 patients with post- traumatic bone infection and implant- related bone infection treated with two kinds of antibiotic- impregnated drug delivery systems locally used after debridement were retrospectively reviewed. There were 14 males and 18 females,with an average age of 46 years（15- 61 years）. There were 20 cases of bone infection after fracture internal fixation,4 open tibial fracture complicated with infection and 8 cases of traumatic bone infection. Sixteen cases were on left and right side respectively. The infection foci lied in femur 4,tibia 16,humerus 2,calcaneus 8,metatarsus 2. Antibiotic- impregnated polymethylmethacrylate（ PMMA） cement beads were used for the initial 6 cases,and biodegradable antibiotic- impregnated calcium sulfate in the next 26 cases. The main measurement parameters included：eradication of infection,rate and time of bone union /void consolidation,and reoperation rate. [Result]The patients were followed up for an average of 28 months（12- 47 months）.Infection was primarily eradicated in 25 patients with a primary infection eradication rate of 78. 1%,and re- operation rate of21. 9%. Five cases achieved eradicating infection in recurrent 7 cases,with a secondary infection eradication rate of 93. 7%.There were 30 patients who achieved bone union / void consolidation,with the bone healing rate of 93. 7%. The average bone union time was 4. 2 months（3- 6 m）,with the void consolidation time 5. 2 months（2- 8 m）. The calcium sulfate blocks were absorbed with an average of 8 weeks（4 weeks- 7 months）. [Conclusion]The study shows that both antibiotic- impregnated PMMA cement beads and antibiotic- impregnated calcium sulfate can achieve good clinical result with high infection eradication rate and bone union / void consolidation rate in treating patients with post- traumatic and implant- related bone infection. Calcium sulfate is more optimal alternation due to having duel function of anti- infection and bone repair.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第10期877-881,共5页
Orthopedic Journal of China
关键词
抗生素
药物缓释系统
骨髓炎
生物材料
骨折
治疗
antibiotics drug controlled delivery system bone infection biomaterial fracture therapy
