鼻环引流辅助胫骨横向骨搬移治疗足踝部慢性骨髓炎的疗效分析  

Tibial transverse bone transport assisted by nose ring drainage for treatment of foot and ankle chronic osteomyelitis

作　　者：杨华清[1] 章耀华[1] 张鸿悦 杨启昌 韩庆海[1] 杨云[1] 赵殿钊 曲龙 Yang Huaqing;Zhang Yaohua;Zhang Hongyue;Yang Qichang;Han Qinghai;Yang Yun;Zhao Dianzhao;Qu Long(Department of Orthopedics,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院骨科,北京100144

出　　处：《中华创伤骨科杂志》2023年第4期302-309,共8页Chinese Journal of Orthopaedic Trauma

基　　金：首都卫生发展科研专项(2022-2-2253);首都临床特色应用研究与成果推广(Z1611000-00516126)。

摘　　要：目的:探讨鼻环引流(NRD)技术辅助胫骨横向骨搬移技术治疗足踝部慢性骨髓炎的疗效。方法:回顾性分析2013年3月至2022年2月期间首都医科大学附属北京康复医院骨科治疗的32例足踝部慢性骨髓炎患者资料。按照手术方式不同将患者分为2组:对照组15例,男12例,女3例;年龄(39.5±8.8)岁;骨髓炎部位:胫骨远端4例,距骨1例,跟骨2例,中足骨4例,前足骨4例;Crerny-Mader分型:Ⅰ型5例,Ⅱ型10例;在彻底清创、抗感染治疗的基础上结合Ilizarov胫骨横向骨搬移技术治疗。研究组17例,男12例,女5例;年龄(42.3±13.4)岁;骨髓炎部位:胫骨远端4例,距骨1例,跟骨3例,中足骨5例,前足骨4例;Crerny-Mader分型:Ⅰ型7例,Ⅱ型10例;在对照组的基础上增加NRD技术治疗。通过比较两组患者的治愈、复发、截肢(截趾)情况、抗生素使用时间、创面愈合时间、相关炎性指标[白细胞计数(WBC)、中性粒细胞百分比(NEU)、红细胞沉降率(ESR)、降钙素原、白细胞介素6(IL-6)、C-反应蛋白(CRP)]、术后功能等评价疗效。结果:两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访(36.0±9.8)个月。两组患者治愈情况、截肢(截趾)情况比较差异均无统计学意义(P>0.05);研究组复发情况显著低于对照组,差异有统计学意义(P<0.05)。研究组的抗生素使用时间[(20.7±3.6)d]、创面愈合时间[(88.3±17.1)d]均显著少于对照组[(37.9±6.5)、(102.2±22.6)d],差异均有统计学意义(P<0.05)。术后1周的ESR、IL-6、CRP均显著低于对照组,差异均有统计学意义(P<0.05);术后1周的WBC、NEU、降钙素原与对照组比较差异均无统计学意义(P>0.05);术后1个月研究组所有相关炎性指标与对照组比较差异均无统计学意义(P>0.05)。所有患者术后1周、1个月的WBC、NEU、ESR、降钙素原、IL-6、CRP等炎性指标均较术前显著改善,术后12个月所有患者Maryland足功能评�Objective To investigate the clinical effects of tibial transverse bone transport assisted by nose ring drainage(NRD)in the treatment of foot and ankle chronic osteomyelitis.Methods A retrospective study was conducted to analyze the data of 32 patients with foot and ankle chronic osteomyelitis who had been treated at Department of Orthopedics,Beijing Rehabilitation Hospital from March 2013 to February 2022.The patients were assigned into a study group and a control group.In the control group,there were 12 males and 3 females,aged(39.5±8.8)years.The osteomyelitis was located at the distal tibia in 4 cases,at the talus in 1 case,at the calcaneus in 2 cases,at the midfoot in 4 cases and at the forefoot in 4 cases.According to the Crerny-Mader classification,there were 5 cases of typeⅠand 10 cases of typeⅡ.The control group was treated with Ilizarov transverse tibial bone transport in combination with thorough debridement and anti-infection therapy.In the study group,there were 12 males and 5 females,aged(42.3±13.4)years.The osteomyelitis was located at the distal tibia in 4 cases,at the talus in 1 case,at the calcaneus in 3 cases,at the midfoot in 5 cases and at the forefoot in 4 cases.According to the Crerny-Mader classification,there were 7 cases of typeⅠand 10 cases of typeⅡ.The study group was treated with NRD drainage in addition to the procedures in the control group.The curative effects were evaluated by comparing the cure,recurrence,amputation(toe amputation),antibiotic use time,wound healing time,relevant inflammatory indicators[WBC,neutrophil percentage(NEU),erythrocyte sedimentation rate(ESR),procalcitonin,interleukin-6(IL-6),C-reactive protein(CRP)],and postoperative functional recovery between the 2 groups.Results The 2 groups were comparable because there was no statistically significant difference in the general data between them(P>0.05).The follow-up period was(36.0±9.8)months.There was no significant difference between the 2 groups in the cure or amputation(toe amputation)(P>0.05),but the

关 键 词：骨髓炎 感染 骨搬移 伊利扎罗夫技术 鼻环引流 

分 类 号：R681.2[医药卫生—骨科学]