万古霉素对自体骨植骨时脊柱融合骨愈合的影响  

Effect of vancomycin on bone healing of spinal fusion during autogenous bone grafting

作　　者：甘维[1] 朱柔霖 刘雪萍[1] 张立岩[1] 刘斌[3] GAN Wei;ZHU Roulin;LIU Xueping;ZHANG Liyan;LIU Bin(Department of Orthopaedics,Lishui People's Hospital in Zhejiang Province,Lishui323000,China;Department of Paediatrics,Lishui People's Hospital in Zhejiang Province,Lishui323000,China;Department of Spinal Surgery,Lishui People's Hospital in Zhejiang Province,Lishui323000,China)

机构地区：[1]浙江省丽水市人民医院骨科,浙江丽水323000 [2]浙江省丽水市人民医院小儿科,浙江丽水323000 [3]浙江省丽水市人民医院脊柱外科,浙江丽水323000

出　　处：《中国现代医生》2020年第3期75-78,82,共5页China Modern Doctor

基　　金：浙江省公益技术应用研究(实验动物)项目(2017C37158);浙江省丽水市公益技术应用研究计划(2017GYX 16);浙江省丽水市高层次人才培养资助项目(2018RC08)。

摘　　要：目的探讨万古霉素对自体骨植骨时脊柱融合骨愈合的影响。方法选取2018年6月~2019年1月我院收治的腰椎退变性疾病患者72例,两组均在脊柱融合时使用自体骨植骨,依据术后不同的干预方式,将患者分成两组,对照组应用常规围术期感染预防方案;研究组联合应用万古霉素。观察比较两组手术过程中出血量、手术时长、引流管留置比率、融合节段数>2以及住院时长;两组的脊柱融合骨愈合情况;两组术后不同时间点的感染发生比率。结果两组手术过程中出血量、手术时长、引流管留置比率、融合节段数>2方面无显著差异(P>0.05),研究组住院时长短于对照组(P<0.05)。术后6个月,两组在脊柱融合骨愈合分级情况方面无显著性差异(P>0.05)。研究组术后共发生2例(5.6%)感染,对照组术后共发生5例(13.9%)感染;研究组不同时间点下及总感染发生率显著低于对照组,差异有统计学意义(P<0.05)。结论应用自体骨植骨进行脊柱融合时联合应用万古霉素,可显著降低患者术后发生感染的风险,缩短患者的住院时长,且不会对患者的骨愈合产生不良影响。Objective To investigate the effect of vancomycin on the bone healing of spinal fusion during autogenous bone grafting. Methods 72 patients with lumbar degenerative disease admitted to our hospital from June 2018 to January 2019 were enrolled. Both groups used autogenous bone grafting during spinal fusion. According to different intervention methods, patients were divided into two groups. The control group was treated with routine perioperative infection prevention program, and the study group was treated with the combination of vancomycin. The blood loss, duration of operation, drainage tube indwelling ratio, fusion segment number>2,hospital stay and bone healing of spinal fusion between the two groups and the incidence of infection between two groups at different time points after surgery were observed and compared. Results There was no significant difference of blood loss, duration of operation, drainage tube indwelling ratio, fusion segment number>2 between the two groups(P>0.05), the hospital stay in the study group was shorter than that in the control group(P<0.05). There was no significant difference in the bone healing classification of spinal fusion between the two groups at 6 months after surgery(P>0.05). A total of 5.6%(2 cases) of infection occurred in the study group, and 13.9%(5 cases)infection occurred in the control group after surgery. The infection rate of the study group at the different time points was significantly lower than that of the control group(P<0.05). Conclusion The combination of autologous bone grafting and vancomycin for spinal fusion can significantly reduce the risk of postoperative infection and shorten the length of hospital stay, without adversely affecting bone healing.

关 键 词：万古霉素 脊柱融合 自体骨植骨 感染 骨愈合 

分 类 号：R687.3[医药卫生—骨科学]