摘要
目的探讨负载万古霉素硫酸钙Ⅰ期治疗慢性骨感染的疗效。方法采用回顾性病例系列研究分析2014年1月-2016年4月收治的26例慢性骨感染患者临床资料，其中男23例，女3例；年龄16-90岁，平均35．8岁。均为创伤性骨感染。手术彻底清除骨感染病灶后填人负载万古霉素的硫酸钙人工骨，致病菌不明确者同时加入庆大霉素，配合全身应用抗生素。其中3例术中因皮肤张力较大，同时行皮瓣转移修复术。术后早期观察伤口愈合情况，定期复查局部有无红肿、窦道复发，拍摄X线片观察骨感染、骨缺掼恢复情况。结果26例均获随访6～30个月，平均19．5个月。23例伤口Ⅰ期愈合；1例伤口渗液换药愈合；1例局部软组织覆盖不良，再次手术行皮瓣转移修复后伤口愈合；1例经历2次手术不愈，采用感染骨段切除Masqueqlet膜诱导技术治愈。随访期间局部骨缺损修复，无骨感染复发。结论对于慢性骨感染患者，负载万古霉素硫酸钙I期治疗可在控制感染的同时修复骨缺损，是一个简单有效的方法，值得推广。
Objective To observe the effect of vancomycin-loaded calcium sulfate for one-stage treatment of chronic osteomyelitis. Methods A retrospective case series study was made on 26 patients with chronic osteomyelitis treated from January 2014 to April 2016. There were 23 males and 3 females, with a mean age of 35. 8 years （range, 16-90 years）. After focus debridement of osteomyelitis, the cavities were filled with vancomycin-loaded calcium sulfate and systemic antibiotics were used. Meanwhile, gentamicin was added to patients showing unclear pathogens. Three patients underwent flap transfer surgery simultaneously due to the inadequate soft tissue coverage. Wound healing, local redness and swelling, sinus recurrence, recovery of osteomyelitis and repair of bone defect were detected after operation. Results All patients were followed up for 6-30 months （ mean, 19.5 months）. Primary healing was achieved in all patients. One patient experienced wound exudate and was effectively managed by dressing change, one patient experienced inadequate local soft tissue coverage and was effectively managed by a second flap transfer surgery, and one patient remained wound unhealing after two surgeries and was cured by infected bone resection using the Masquelet induced membrane technique. Follow-up showed local bone defect was repaired in all patients without bone infection recurrence. Conclusions For patients with chronic osteomyelitis, one-stage surgery with vancomycin-loaded calcium sulfate can control infection with simultaneous repair of bone defect. Therefore, the procedure is a simple and effective method and worthy of clinical practice.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第4期349-354,共6页
Chinese Journal of Trauma
关键词
硫酸钙
万古霉素
慢性骨感染
Calcium sulfate
Vancomycin
Chronic steomyelitis
