抗生素硫酸钙结合骨搬运技术治疗下肢创伤后感染性骨缺损的临床疗效  

Clinical effect of antibiotic calcium sulfate combined with bone transport technique on infectious bone defect of lower extremity after trauma

作　　者：何昌军 张堃[1] 任程[1] 黄强[1] 李明[1] 路遥[1] 许毅博 熊晨 李忠[1] 马腾[1] HE Changjun;ZHANG Kun;REN Cheng;HUANG Qiang;LI Ming;LU Yao;XU Yibo;XIONG Chen;LI Zhong;MA Teng(Department of Trauma Orthopaedics,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科,西安710054

出　　处：《中华骨与关节外科杂志》2022年第5期334-340,共7页Chinese Journal of Bone and Joint Surgery

基　　金：陕西省自然科学基金(2022JQ-757,2021SF-243)

摘　　要：目的:探讨抗生素硫酸钙结合骨搬运技术治疗下肢创伤后感染性骨缺损的临床疗效。方法:回顾分析2016年1月至2019年6月采用抗生素硫酸钙结合骨搬运技术治疗的18例下肢创伤后感染性骨缺损患者的临床资料。男14例,女4例;年龄28~57岁,平均(39.0±8.0)岁。病程6~25个月,平均(11.9±5.7)个月。清创后骨缺损长度为4~10 cm,平均(6.3±1.9)cm。彻底清创后在骨缺损处填充抗生素硫酸钙,安装骨搬运外固定架并于术前设计部位截骨,行骨搬运治疗。记录术前白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、红细胞沉降率(ESR)及骨愈合时间、外固定指数(EFI),并观察并发症发生情况。术后2周、4周、6周、1年复查WBC、CRP、PCT、ESR等炎症指标,根据Ilizarov方法研究与应用协会(ASAMI)评分评价骨愈合与功能结果。结果:18例患者获得15~51个月随访,平均(30.5±9.3)个月。16例患者一期骨性愈合,愈合时间7~15个月,平均(11.7±2.0)个月。EFI为1.2~2.8月/厘米,平均(2.0±0.5)月/厘米。针道感染、轴线偏移、无菌性渗液和对接端不愈合发生率分别为27.7%、22.2%、38.9%和11.1%。术后各时间点炎症指标均较术前降低(P<0.05);术后1年WBC、PCT、ESR与术后6周比较,差异无统计学意义(P>0.05),其他时间点均有统计学意义(P<0.05)。2例患者出现踝关节僵硬。所有患者无骨搬运段矿化不良、感染复发、截肢、血管神经损伤等发生,肢体力线及长度恢复良好。根据ASAMI评分,末次随访时骨愈合结果的优良率为83.3%(15/18),功能结果优良率为88.9%(16/18)。结论:抗生素硫酸钙结合骨搬运技术治疗下肢创伤后感染性骨缺损可以有效控制感染、降低对接端不愈合率、恢复肢体功能,获得较好的临床疗效。Objective:To investigate the clinical effect of calcium sulfate combined with bone transport on post-traumatic infectious bone defects of lower extremity.Methods:A retrospective analysis was performed in 18 patients with post-traumatic infectious bone defects of lower extremity treated by antibiotic calcium sulfate combined with bone transport technology from January 2016 to June 2019.There were 14 males and 4 females with a mean age of(39.0±8.0)years(range,28-57 years).The mean course of disease was(11.9±5.7)months(range,6-25 months).The mean length of bone defects was(6.3±1.9)cm(range,4-10 cm).After debridement,antibiotic calcium sulfate was filled with and external bone transport fixator was installed in all patients.The position of osteotomy was designed for bone transport treatment.White blood cell(WBC)count,C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),healing time,external fixation index(EFI)and the incidence of complications were recorded.Bone and functional results were evaluated according to the Ilizarov Association for Research and Application of Methods(ASAMI)scoring system.Results:The mean duration of follow-up was(30.5±9.3)months(range,15-51 months).Primary bone healing was achieved in 16 patients,and the mean healing time was(11.7±2.0)months(range,7-15 months).The mean EFI was(2.0±0.5)months/cm(range,1.2-2.8)months/cm.The incidence of needle infection,axis deviation,aseptic exudation and nonunion of the butt end was 27.7%,22.2%,38.9%and 11.1%,respectively.The inflammatory indexes were significantly decreased after surgery(P<0.05).There was no significant difference between WBC,PCT and ESR 1 year after surgery and those indexes at 6 weeks after surgery(P>0.05),while significant difference was found in the rest time points(P<0.05).Two patients developed ankle stiffness.No poor mineralization of bone transport segment,recurrence of infection,amputation,vascular or nerve injury occurred,and limb force line and length recovered well.At the last follow-up,the excell

关 键 词：骨搬运技术 骨缺损 硫酸钙 骨感染 

分 类 号：R687.3[医药卫生—骨科学]