病灶清除结合载抗生素磷酸钙治疗儿童急性血源性骨髓炎  

Lesion clearance combined with antibiotic-loaded calcium phosphate for treatment of acute hematopoietic osteomyelitis in children

作　　者：田永福 李阳阳 卢博 刘继权 郭建刚 TIAN Yongfu;LI Yangyang;LU Bo;LIU Jiquan;GUO Jiangang(Department of Osteomyelitis, Luoyang Orthopedic Hospital of Henan province (Orthopedic Hospital of Henan Province), Zhengzhou 450000, China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)骨髓炎科,450000

出　　处：《国际骨科学杂志》2020年第6期361-364,共4页International Journal of Orthopaedics

摘　　要：目的探讨病灶清除结合载抗生素磷酸钙植入治疗儿童急性血源性骨髓炎的临床疗效。方法回顾性分析2015年6月至2019年2月治疗的33例急性血源性骨髓炎患者临床资料,其中男20例,女13例,年龄2~16岁,平均(10.2±3.5)岁;胫骨骨髓炎10例,腓骨骨髓炎4例,股骨骨髓炎15例,肱骨骨髓炎1例,跟骨骨髓炎2例,骶骨骨髓炎1例。所有患者均行骨质开窗病灶清除结合载抗生素磷酸钙人工骨植入治疗。比较患者术前及术后4周的白细胞、血小板、红细胞沉降率(ESR)、C-反应蛋白(CRP),患肢功能恢复情况,患肢骨髓炎治愈情况。结果 33例患者随访12~42个月,平均(18.2±5.6)个月。2例股骨骨髓炎、胫骨骨髓炎累及骺线的患者患肢分别较对侧长1.1cm、1.3cm,行走未见明显跛行。1例患者胫骨远端病变术后出现病理性骨折,给予石膏固定后骨折愈合。1例跟骨感染及1例股骨感染患者术后复发,经再次病灶清除后感染控制。患者术前及术后4周的白细胞、血小板、ESR及CRP有统计学差异(P<0.05),患肢功能恢复良好,骨髓炎临床治愈率达93.9%。结论病灶清除结合载抗生素磷酸钙植入治疗儿童急性血源性骨髓炎,能较快缓解患者炎症反应,改善患肢功能,提高骨髓炎治愈率。Objective To investigate the clinical efficacy of lesion clearance combined with antibiotic-loaded calcium phosphate for treatment of acute hematopoietic osteomyelitis in children.Methods From June 2015 to February 2019,the clinical data of 33 patients(20 boys and 13 girls)with acute hematopoietic osteomyelitis were retrospectively analyzed.Their ages ranged from 2 to 16 years old,with an average of10.2±3.5 years old.There were 10 cases of tibia osteomyelitis,4 cases of fibula osteomyelitis,15 cases of femur osteomyelitis,1 case of humerus osteomyelitis,2 cases of calcaneus osteomyelitis and 1 case of sacrum osteomyelitis.All patients were treated with bone fenestration and lesion clearance,and implanted with antibiotic-loaded calcium phosphate cement.The count of white blood cells and platelets,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),functional recovery and osteomyelitis cure rate of the limb were compared between before surgery and 4 weeks postoperatively.Results The average follow-up was 18.2±5.6(range,12 to 42)months.One case of femur osteomyelitis and one case of tibia osteomyelitis involving epiphyseal line had limbs 1.1 and 1.3 cm longer than the opposite side,respectively,but without noticeable limp.One patient had a pathological fracture of the distal tibia after surgery,and treated with a cast until fracture union.Infection recurrence were found in 1 case of calcaneus and 1 case of femur osteomyelitis,and both received a second operation to clear the lesions.There were significantly statistical differences in terms of the count of white blood cells and platelets,ESR and CRP(all P<0.05)between before surgery and 4 weeks postoperatively.The function of all affected limbs was improved after treatment.The overall clinical cure rate was 93.9%.Conclusion Lesion clearance combined with antibioticloaded calcium phosphate for treatment of acute hematopoietic osteomyelitis in children could quickly alleviate the inflammatory response in patients and improve the limb function and the cure rat

关 键 词：病灶清除 磷酸钙 血源性骨髓炎 

分 类 号：R68[医药卫生—骨科学]