载万古霉素硫酸钙人工骨治疗慢性骨髓炎的临床效果  

Analysis of the efficacy of vancomycin loaded calcium sulfate artificial bone in the treatment of chronic osteomyelitis

作　　者：王勇 王海滨[2] 张晓荣[2] 孙法同 邢宝杰 于雪淳 谭清实[2] 贾代良 WANG Yong;WANG Haibin;ZHANG Xiaorong;SUN Fatong;XING Baojie;YU Xuechun;TAN Qingshi;JIA Daliang(School of Clinical Medicine,Jining Medical University,Jining 272013,China;Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院临床医学院,济宁272013 [2]济宁医学院附属医院,济宁272029

出　　处：《济宁医学院学报》2022年第2期102-105,共4页Journal of Jining Medical University

基　　金：济宁医学院国家自然(社会)科学基金培育项目(JYP2019KJ17)。

摘　　要：目的探讨载万古霉素的硫酸钙人工骨治疗慢性骨髓炎的临床效果分析。方法回顾性分析2016年1月至2021年1月济宁医学院附属医院收治的13例慢性骨髓炎患者的临床资料,其中男性9例,女性4例;年龄18~69岁,平均36.2岁。采用彻底清除感染性病灶,腔内植入载有抗生素万古霉素的硫酸钙人工骨,根据术中评估,感染部位清创后骨质破坏严重影响稳定性,采用外固定支架保护性治疗3例,若出现大段骨缺损,肢体稳定性差则采用环形外固定架治疗1例,同时根据实验室细菌培养+药敏实验结果,静脉输注敏感抗生素。术后观察术区及窦道愈合、感染指标控制、骨组织生长等情况。结果术后随访3~24个月,9例伤口甲级愈合,4例出现伤口延迟愈合,主要为伤口的无菌性渗出,经换药后伤口自行愈合,复查感染指标均恢复正常。随访复查X光片见术区填充的载万古霉素的硫酸钙颗粒逐渐被吸收,新生骨组织生长,最终达到骨性愈合,患者肢体功能恢复。结论载万古霉素的硫酸钙治疗慢性骨髓炎,有效控制感染,修复骨缺损,缩短治疗周期,降低患者复发率,达到载药治疗和骨组织重建的双重治疗目的。Objective To investigate the efficacy of vancomycin calcium sulfate artificial bone in the treatment of chronic osteomyelitis.Methods The clinical data of 13 patients with chronic osteomyelitis treated in the Affiliated Hospital of Jining Medical College from January 2016 to January 2021 were analyzed retrospectively,including 9 males and 4 females;the age ranged from 18 to 69,with an average age of 36.2.In these cases,after complete elimination of infectious site,calcium sulfate artificial bones containing vancomycin were implanted.According to the intraoperative evaluation,the bone destruction after debridement of the infected site seriously affected the stability.3 cases were treated with external fixation.1 case was treated with circular external fixation when there was a large bone defect and poor limb stability.At the same time,according to the results of laboratory bacterial culture+drug sensitivity test,intravenous infusion of sensitive antibiotics was applied.The healing of the operation area and sinus tract,the results of infection indexes and the growth of bone tissue were observed after operation.Results After follow-up for 3~24 months,9 cases had grade A wound healing,and 3 cases had delayed wound healing,mainly aseptic exudation of the wound.After dressing change,the wound healed itself,and the infection indexes returned to normal or decreased significantly.The follow-up X-ray showed that the calcium sulfate particles loaded with vancomycin filled in the operation area were gradually absorbed,the new bone tissue grew,and finally achieved bone healing,and the patient's limb function recovered.Conclusion Vancomycin loaded calcium sulfate in the treatment of chronic osteomyelitis can effectively control infection,repair bone defects,shorten the treatment cycle,reduce the recurrence rate,and achieve the dual therapeutic purposes of drug loading treatment and bone tissue reconstruction.

关 键 词：慢性骨髓炎 万古霉素 硫酸钙 感染 

分 类 号：R653[医药卫生—外科学]