病灶清除联合一期植入载万古霉素自固化磷酸钙骨水泥对Ⅲ/Ⅳ型慢性骨髓炎的疗效分析  

Analysis of efficacy of focus debridement combined with one-stage implantation of vancomycin-loaded calcium phosphate cement in the treatment of typeⅢ/Ⅳchronic osteomyelitis

作　　者：梁佳佳[1] 廖涛[1] 彭饶 郎志刚[1] Liang Jiajia;Liao Tao;Peng Rao;Lang Zhigang(Department of Osteopathy,Sichuan Provincial Orthopedics Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院骨科,成都610041

出　　处：《中国医学前沿杂志（电子版）》2021年第1期103-108,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的分析病灶清除联合一期植入载万古霉素自固化磷酸钙骨水泥(calcium phosphate cement,CPC)对Ⅲ/Ⅳ型慢性骨髓炎的疗效。方法选取2017年2月至2019年1月四川省骨科医院收治的102例Cierny-MaderⅢ/Ⅳ型慢性骨髓炎患者为研究对象,采用随机数字表法将其分为CPC组和聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)组,每组各51例,给予CPC组患者病灶清除联合一期植入载万古霉素CPC治疗,给予PMMA组患者病灶清除联合一期植入载庆大霉素PMMA骨水泥治疗,在治疗和随访期间两组均有患者失访,予以剔除,最终CPC组纳入49例患者,PMMA组纳入47例患者。比较两组患者的临床疗效、感染控制时间、术后1年复发率、术后并发症发生情况、视觉模拟评分法(visual analogue scale,VSA)评分、血清C-C型趋化因子配体11(C-C motif chemokine ligand 11,CCL11)和C反应蛋白(C reactive protein,CRP)水平、简式Fugl-Meyer运动功能评定量表(Fugl-Meyer assessment,FMA)评分。结果CPC组患者临床疗效显著优于PMMA组(P<0.05),感染控制时间显著短于PMMA组(P<0.05),术后1年复发率显著低于PMMA组(P<0.05)。两组患者术后并发症发生情况比较差异无统计学意义(P>0.05)。术后1个月,CPC组患者VAS评分显著低于PMMA组(P<0.05)。术后2个月和3个月,CPC组患者血清CCL11和CRP水平均显著低于PMMA组(均P<0.05)。术后1年,CPC组患者上、下肢简式FMA评分均显著高于PMMA组(均P<0.05)。结论病灶清除联合一期植入载万古霉素CPC和载庆大霉素PMMA骨水泥治疗慢性骨髓炎均有效,但载万古霉素CPC的疗效更佳,其在控制感染、促进骨修复和患肢功能恢复方面的作用更强,能进一步改善慢性骨髓炎患者预后。Objective To observe the efficacy of focus debridement combined with one-stage implantation of vancomycin-loaded calcium phosphate cement(CPC)in the treatment of typeⅢ/Ⅳchronic osteomyelitis.Method One hundred and two patients with Cierny-Mader typeⅢ/Ⅳchronic osteomyelitis treated in Sichuan Provincial Orthopaedics Hospital from February 2017 to January 2019 were selected as the study subjects,and they were divided into CPC group and polymethylmethacrylate(PMMA)group by using the random number table method,with 51 cases in each group.CPC group patients were treated with focus debridement combined with one-stage implantation of vancomycin-loaded CPC treatment,and PMMA group patients were treated with focus debridement combined with one-stage implantation of gentamicin-containing PMMA bone cement treatment.There were patients in both groups lost to follow-up during treatment and follow-up,and they were excluded.Finally,49 cases were included in CPC group and 47 cases in PMMA group.The clinical efficacy,infection control time,recurrence rate of 1 year after operation,occurrence of postoperative complications,visual analogue scale(VSA)score,serum C-C motif chemokine ligand 11(CCL11)and C reactive protein(CRP)and simple Fugl-Meyer assessment(FMA)score were compared between the two groups.Result The clinical curative effect of CPC group was significantly better than that of PMMA group(P<0.05),the time of infection control was significantly shorter than that of PMMA group(P<0.05),and the recurrence rate of 1 year after operation was significantly lower than that of PMMA group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).One month after operation,the VAS score in CPC group was significantly lower than that in PMMA group(P<0.05).At 2 and 3 months after operation,the levels of serum CCL11 and CRP in CPC group were significantly lower than those in PMMA group(all P<0.05).One year after operation,the simple FMA scores of upper and lower lim

关 键 词：慢性骨髓炎 自固化磷酸钙骨水泥 聚甲基丙烯酸甲酯骨水泥 

分 类 号：R687.3[医药卫生—骨科学]