载药硫酸钙富血小板血浆治疗股骨慢性骨髓炎  

Antibiotic-loaded calcium sulfate combined with platelet-rich plasma for chronic osteomyelitis of the distal femur

作　　者：王朝辉[1] 王碾栓 詹晓欢 高峻青[1] WANG Zhao-hui;WANG Nian-shuan;ZHANG Xiao-huan;GAO Jun-qing(Department of Reparative and Reconstructive Surgery,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China;Department of Orthopedics,Foshan Chancheng High-tech Area Hospital,Foshan 528000,China)

机构地区：[1]佛山市中医院修复重建外科,广东佛山528000 [2]佛山禅城高新区医院骨科,广东佛山528000

出　　处：《中国矫形外科杂志》2023年第9期839-842,共4页Orthopedic Journal of China

基　　金：广东省科学技术厅项目(编号:2020B1111150001);佛山市重点领域科技攻关项目(编号:2020001006106);佛山市科技创新项目(编号:2020001005776)。

摘　　要：[目的]介绍载药硫酸钙富血小板血浆治疗Cierny-Mader III型股骨中下段慢性骨髓炎的手术技巧和初步临床效果。[方法]2017年1月-2020年6月,对15例Cierny-MaderⅢ型股骨中下段慢性骨髓炎的患者,一期予高速钻头沿感染皮质骨边缘散在钻孔,摆锯、薄骨刀进行局部开窗,予咬骨钳清除硬化骨质、脓腔、炎性肉芽肿,予生理盐水、安尔碘反复冲洗。予钻头打通感染骨段远近端闭锁髓腔,放置负压封闭引流。二期沿原切口暴露骨缺损区,制备载药硫酸钙颗粒,将颗粒状硫酸钙与PRP混合,填塞股骨感染骨段髓腔,放置引流。[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症。所有患者均获随访,随访时间平均(26.1±6.3)个月,末次随访时,患肢疼痛VAS评分和HSS膝关节评分均显著改善(P<0.05)。影像检查见感染部位成骨良好。[结论]在开窗扩髓引流的基础上,载药硫酸钙富血小板血浆可有效治疗Cierny-MaderⅢ型股骨中下段慢性骨髓炎。[Objective]To introduce the surgical technique and preliminary clinical results of antibiotic-loaded calcium sulfate combined with platelet-rich plasma for treatment of chronic osteomyelitis of the distal femur.[Methods]From January 2017 to June 2020,15 patients received abovementioned therapy for Cierny-Mader type III chronic osteomyelitis in the distal femur.In the first-stage operation,the cortical bone margin over the infected lesion were drilled with a high-speed drill,fenestrated with a thin osteotome,debrided to remove all the sclerosing bone,abscess and inflammatory tissue,and rinsed with normal saline and Entoiodine repeatedly.The proximal and distal medullary cavities were opened by gradual drill bits,and negative-pressure closed drainage was placed.A week later,the second-stage operation was conducted through the original incision.After debridement,sensitive antibiotics loaded calcium sulfate particles were prepared,then mixed with PRP to fill the medullary cavity with drainage placed.[Results]All patients had operations successfully completed with no vascular nerve injury and other serious complications.All patients were followed up for an average of(26.1±6.3)months.At the last followup the pain VAS score and HSS knee score of the affected limb were significantly improved(P<0.05).The images showed good osteogenesis at the lesion site.[Conclusion]This antibiotic-loaded calcium sulfate combined with platelet-rich plasma does effectively treat chronic osteomyelitis of the distal femur.

关 键 词：股骨 慢性骨髓炎 载药硫酸钙 富血小板血浆 

分 类 号：R681.2[医药卫生—骨科学]