载抗生素骨水泥在治疗下肢感染性创面中的疗效分析  

Efficacy analysis of antibiotic bone cement in treating infectious wound of lower extremity

作　　者：尤加省[1] 李宏烨[1] 刘超[1] YOU Jia-xing;LI Hong-ye;LIU Chao(Xiasha Campus,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310018,Zhejiang,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区,浙江杭州310018

出　　处：《中国骨伤》2021年第7期670-673,共4页China Journal of Orthopaedics and Traumatology

基　　金：浙江省中医药科学研究基金项目(编号:2017ZB062)。

摘　　要：目的:探讨载抗生素骨水泥在治疗下肢感染性创面中的临床效果。方法:2016年1月至2019年1月采用载抗生素骨水泥治疗28例下肢感染性创面患者,其中男21例,女7例;年龄34~76(53.8±16.5)岁。患者术前均有不同程度的下肢皮肤软组织缺损伴感染,创面形成时间8~40(24.6±9.5)d;初次清创后创面面积4 cm×3 cm~12 cm×8 cm,清创后使用载抗生素骨水泥制成片状覆盖创面,待感染得到控制、创面新鲜肉芽组织生长后再行局部缝合、换药或植皮术。记录并比较术前和术后2周患者的白细胞计数(white blood cell,WBC),红细胞沉降率(erythrocyte sedimentation rate,ESR),C-反应蛋白(C reactire protein,CRP),创面分泌物细菌培养阳性率的变化;统计创面新鲜肉芽形成时间、感染复发率及并发症情况。结果:所有患者获得随访,时间3~6(4.3±1.2)个月。3例糖尿病足创面感染复发后出现不同程度的破溃,其余患者创面愈合良好,无感染加重、截肢等严重并发症发生。患者术后2周的WBC(9.1±1.2)×109/L、ESR(23.5±7.6)mm/h、CRP(44.2±13.1)mg/L分别较术前的(11.4±2.2)×109/L、(57.1±14.9)mg/L、(89.2±26.7)mg/L明显下降(P<0.05);创面新鲜肉芽形成时间12~21(15.6±3.2)d。结论:载抗生素骨水泥治疗下肢感染性创面能有效控制感染、促进创面新鲜肉芽组织生长和创面的愈合。Objective:To discuss the clinical effect of antibiotic bone cement in the treatment of infectious wound of lower extremity.Methods:From January 2016 to January 2019,28 patients who had infection wounds of lower extremity were treated by antibiotic bone cement,including 21 males and 7 females with age of 34 to 76(53.8±16.5)years old.The wound area after the initial debridement was 4 cm×3 cm to 12 cm×8 cm.All patients were treated with the antibiotic bone cement,when infection was controlled and fresh granulation tissue grew on the wound surface,local sutures or skin grafts were performed.The changes of white blood cell(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and positive rate of bacterial culture of wound secretions were recorded and compared before and after 2 weeks of the operation.The healing time,recurrence rate and complications of fresh granulation on wound surface were calculated.Results:All patients were followed up for 3 to 6(4.3±1.2)months.After the recurrence of diabetic foot wound infection,3 patients presented different degree of rupture,and the remaining patients had good wound healing.No serious complications such as aggravation of infection and amputation occurred.The WBC,ESR and CRP of the patients were decreased significantly after operation compared with that before operation(9.1±1.2)×109/L vs.(11.4±2.2)×109/L,(23.5±7.6)mm/h vs.(57.1±14.9)mg/L,(44.2±13.1)mg/L vs.(89.2±26.7)mg/L(P<0.05).The formation time of fresh granulation on the wound surface was 12 to 21(15.6±3.2)days.Conclusion:The antibiotic bone cement can control infection of lower extremity wound effectively,promote the growth of fresh granulation tissue and wound healing.

关 键 词：骨水泥 抗菌药 感染创面 外科手术 

分 类 号：R632.1[医药卫生—外科学]