一期手术治疗63例Cierny-Mader Ⅱ型及Ⅲ型慢性跟骨骨髓炎的单中心临床诊疗分析  

One-stage surgical treatment for Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis:Single-centre experience of 63 cases

作　　者：朱岩 朱杰 周光新 钱红波 何志伟 ZHU Yan;ZHU Jie;ZHOU Guang-xin;QIAN Hong-bo;HE Zhi-wei(Department of Orthopaedics,Eastern Theater General Hospital of PLA,Nanjing,Jiangsu 210002,China)

机构地区：[1]解放军东部战区总医院骨科,江苏南京210002

出　　处：《中华全科医学》2021年第10期1654-1657,1684,共5页Chinese Journal of General Practice

基　　金：江苏省卫生健康委科研项目(M2020025)。

摘　　要：目的慢性跟骨骨髓炎致病因素多,分型复杂,治疗具有挑战性。本研究回顾性分析Cierny-MaderⅡ型及Ⅲ型慢性跟骨骨髓炎的临床特点,并探究采用一期手术的临床疗效和影响肢体功能的相关因素。方法回顾性分析东部战区总医院2005年1月-2018年12月收治的63例Cierny-MaderⅡ型及Ⅲ型慢性跟骨骨髓炎患者,其中男性55例,女性8例;年龄6~68岁,中位年龄为39(23,57)岁。Cierny-Mader分型:Ⅱ型32例,Ⅲ型31例。32例Ⅱ型患者单纯采取一期病灶清除,18例Ⅲ型患者采取病灶清除后植入自体骨,13例Ⅲ型患者采取病灶清除后抗生素骨水泥填塞。采用AOFAS-AH评分量表对患肢术后功能评估。结果 63例患者均获随访,随访时间12~68个月。8例患者复发,其中32例Ⅱ型患者中5例复发;采自体髂骨植入的18例Ⅲ型患者中2例复发;采取抗生素骨水泥填塞的13例Ⅲ型患者中1例复发。63例患者术前AOFAS评分为(63.4±7.6)分,术后AOFAS评分为(84.8±7.4)分。统计分析后发现术前肢体功能与Cierny-Mader分型(P<0.001)及跟骨骨髓炎的病因(P=0.005)有关,术后AOFAS评分与患者年龄(P=0.018)及病因(P=0.035)相关。结论一期手术治疗周期短,疗效良好,是治疗Cierny-MaderⅡ型及Ⅲ型慢性跟骨骨髓炎的有效手段。Objective Chronic calcaneal osteomyelitis has many pathogenic factors and complex classification, and it is challenging to treat. This study retrospectively analysed the clinical characteristics of Cierny-Mader type Ⅱ and Ⅲ chronic calcaneal osteomyelitis and explored the clinical efficacy of one-stage surgery and related factors of limb function. Methods A retrospective case series study was conducted to analyse the clinical data of 63 patients with Cierny-Mader type Ⅱ and Ⅲ chronic calcaneus osteomyelitis admitted at the Eastern Theater General Hospital from January 2005 to December 2018. A total of 55 patients were males, and 8 were females. The ages ranged from 6 to 68 years, with the median age of 39(23, 57) years. According to the Cierny-Mader classification, 32 cases had type Ⅱ disease, and 31 had type Ⅲ disease. Thirty-two patients with type Ⅱ disease were treated with debridement, and 18 patients with type Ⅲ disease were treated with autologous bone implantation after debridement. The remaining 13 patients with type Ⅲ disease were treated with antibiotic bone cement after debridement. The American Orthopaedic Foot and Ankle Society’s hind foot(AOFAS-AH) score was used to assess the postoperative limb function. Results All patients were followed up for 12-68 months. A total of 8 cases recurred, of which 5 with type Ⅱ disease recurred. Two of the 18 patients with type Ⅲ disease recurred, and 1 case in 13 patients with type III disease who were treated with antibiotic bone cement after debridement recurred. The AOFAS-AH score improved from preoperative(63.4±7.6) points to postoperative(84.8±7.4) points. After statistical analysis, the preoperative limb function was found to be related to the Cierny-Mader classification(P<0.001) and the aetiology of calcaneal osteomyelitis(P=0.005), and the postoperative AOFAS score was related to the patient’s age(P=0.018) and aetiology(P=0.035). Conclusion One-stage surgery is an effective method for Cierny-Mader type Ⅱ and Ⅲ chronic calcane

关 键 词：跟骨 慢性骨髓炎 手术 

分 类 号：R681.2[医药卫生—骨科学]