骨搬运治疗胫骨慢性骨髓炎,是否需要加用抗生素骨水泥?  

Bone transport for treatment of chronic tibia osteomyelitis: is antibiotics bone cement necessary

作　　者：张永红[1] 秦泗河 王栋[1] 刘来有[1] 

机构地区：[1]山西医科大学第二医院骨科,太原030001 [2]国家康复辅具研究中心附属医院,北京100176

出　　处：《中国矫形外科杂志》2017年第4期331-335,共5页Orthopedic Journal of China

摘　　要：[目的]探讨加用抗生素骨水泥能否减少骨搬运技术治疗胫骨慢性骨髓炎的复发率。[方法]将18例胫骨慢性骨髓炎的患者随机分为两组,一组为对照组,10例,不使用抗生素骨水泥,用油纱填塞骨缺损处;骨水泥组8例,在骨缺损处填充万古霉素骨水泥(20 g骨水泥加入3 g万古霉素)。骨段搬运的过程中,骨缺损处的空间越来越小,逐渐拉出骨水泥链珠或油纱。根据Paley等感染性骨缺损评分标准评定疗效。[结果]10例对照组中的1例出院后失访,其余17例术后获12~47个月(平均31个月)随访,所有的患者感染治愈。骨水泥组平均创口闭合时间为63 d,对照组平均创口闭合时间为69 d;骨缺损端愈合时间骨水泥组平均4.4个月,对照组平均4.3个月。并发症包括钉道感染:骨水泥组7例,对照组9例;>10°的力线偏移:骨水泥组5例,对照组3例,均在随访过程中纠正;关节僵硬:骨水泥组1例,对照组2例;根据Paley感染性骨缺损的评分标准:骨水泥组优7例,良1例,对照组优7例,良2例。两组间比较差异无统计学意义。[结论]即使在骨缺损处不填充抗生素骨水泥,通过彻底清创,骨搬运技术可以很好的治疗胫骨慢性骨髓炎。[Objective] To evaluate whether the antibiotics embedded bone cement can reduce the recurrence of chronic tibia osteomyelitis after bone transport treatment. [Methods] Eighteen patients with chronic tibia osteomyelitis were randomly divided into two groups, including 8 patients in the cement group who had the bone defect filled with vancomycin embedded bone cement （ 3 gram vancomycin in 20 gram bone cement）, while the remaining 10 patients in the non-cement group who were treated with gauze plugging the bone defect instead of antibiotics embedded bone cement. As bone was been transporting and the bone deficiency diminished, the bone cement beads was put out gradually. The results were graded using Paley＇ s criteria. [Results] Except a patient lost follow-up in the non-cement group, the remaining patients were followed up for an average of 31 months, ranged from 12 months to 47 months. All of the patients had the bone infection cured, with the average wound closure time of 63 days in the bone cement group, while 69 days in the non-bone cement group. Solid bony healing achieved in 4.4 months in the bone cement group, whereas 4.3 months in the non-cement group. Pin site infection was found in 7 patients of the cement group, while 9 cases in the non-cement group. Malalignment over 10° was noted in 5 patients of the cement group, whereas 3 patients in the non-cement group, which were corrected in all of the patients during follow-up. Ankylosis was found in a patient of the cement group, while 2 in the non-cement group. However, no joint dislocation and equine talipes were noted in any patient of the both groups. According Paley＇s rating scale, 7 excellent and 1 good outcomes were achieved in the cement group, whereas 7 excellent and 2 good results in non-cement group. [Conclusion] Even without antibiotics embedded bone cement, a thorough debridement followed by bone transport is effective treatment of chronic tibia osteomyelitis.

关 键 词：慢性骨髓炎 骨水泥 骨搬运 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]