载药医用硫酸钙颗粒局部植骨治疗骶髂关节结核  

TREATING SACROILIAC JOINT TUBERCULOSIS WITH RIFAMPICIN-LOADED OsteoSet

作　　者：李硕[1] 刘威[1] 张贺龙[1] 赵大卫[2] 刘丰胜[1] 王淑红 赵飞 

机构地区：[1]河北省胸科医院骨科,石家庄050041 [2]河北省胸科医院胸外科,石家庄050041 [3]河北省计划生育科学技术研究院检验科 [4]河北省宁晋县医院骨科

出　　处：《中国修复重建外科杂志》2015年第4期406-411,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的分析医用硫酸钙与注射用利福平粉末混合植骨治疗骶髂关节结核病灶清除后骨缺损的安全性、可行性和疗效。方法回顾分析2006年8月-2010年8月采用一期病灶清除、医用硫酸钙加注射用利福平局部植骨治疗的27例骶髂关节结核患者临床资料。其中男10例,女17例;年龄16～64岁,平均35.2岁。病程1.5～16个月,平均7.5个月。病变位于左侧16例,右侧10例,双侧1例。其中伴髂窝脓肿18例,臀部脓肿6例。根据Kim分型,Ⅲ型9例,Ⅳ型18例。术前Majeed评分为（61.23±6.49）分;良4例、中19例、差4例,优良率14.81%。结果术后伤口均I期愈合,无骨盆感染、周围神经损伤、下肢深静脉血栓形成等并发症发生。26例获随访,随访时间12～24个月,平均16个月。腰骶及下肢活动、感觉均正常,无会阴感觉障碍。除1例耐多药结核患者于术后3个月局部复发,经调整抗结核药物及营养支持,应用胸腺五肽增强免疫治疗,二次病灶清除术后治愈。25例患者均于术后9～12个月植骨融合,且症状消失,病灶无复发,恢复病前工作。末次随访时Majeed评分为（92.31±3.36）分,与术前比较差异有统计学意义（t=—32.76,P=0.00）;获优22例,良4例,优良率100%,与术前比较差异有统计学意义（χ2=31.93,P=0.00）。结论载有注射用利福平医用硫酸钙颗粒植骨融合是治疗骶髂关节结核病灶清除后骨缺损的安全、有效方法。Objective To assess the safety, feasibility, and effectiveness of medical calcium sulfate（Osteo Set） mixed with powder for injection of rifampicin after radical debridement in the treatment of sacroiliac joint tuberculosis. Methods A retrospective analysis was made on the clinical data from 27 patients with sacroiliac joint tuberculosis who underwent debridement surgery and local bone graft of Osteo Set artificial bone impregnated with powder for injection of rifampicin between August 2006 and August 2010. There were 10 males and 17 females with an average age of 35.2 years（range, 16-64 years）. The mean disease duration was 7.5 months（range, 1.5-16 months）. The left sacroiliac joint was involved in 16 cases, the right side in 10 cases, and both sides in 1 case; Of them, 18 cases had iliac fossa abscess and 6 cases of buttocks abscess. According to the classification system by Kim, there were 9 cases of type III and 18 cases of type IV. The preoperative Majeed score was 61.23±6.49, including good in 4 patients, general in 19 patients, and poor in 4 patients. Results All patients achieved wound healing by first intention; no complications of pelvic infection, peripheral nerve injury, and lower extremity deep vein thrombosis occurred. Twenty-six patients were followed up 16 months on average（range, 12-24 months）. All the patients had normal sense and movement of both lower limbs; no perineum sensory disturbance was found. One case of multi-drug resistant had local recurrence at 3 months after operation, which was cured after adjusting anti-tuberculosis drugs, nutritional support, enhancing immunity with thymopentin, and second operation. Bone union was observed at 10.5 months on average（range, 9-12 months） in 25 patients, and clinical symptoms disappeared with no recurrence or complication, and they returned to previous work. The Majeed score at last follow-up was 92.31±3.36, showing significant difference when compared with preoperative score（t= —32.76, P=0.00）. The results were excellen

关 键 词：骶髂关节结核 医用硫酸钙 利福平缓释体 转化医学 

分 类 号：R529.2[医药卫生—内科学]