载万古霉素骨水泥治疗慢性创伤性骨髓炎的临床应用  

Application of vancomycin-loaded bone cement in treatment of chronic traumatic osteomyelitis

作　　者：祝海炳 张永涛 应昀峰 吕和 ZHU Haibing;ZHANG Yongtao;YING Yunfeng;LYU He(Department of Foot and Ankle Orthopaedics,Zhoushan Hospital of Traditional Chinese Medicine,Zhoushan 316000,China;不详)

机构地区：[1]舟山市中医院足踝儿科,316000 [2]广西中医药大学研究生院

出　　处：《浙江医学》2024年第4期403-407,共5页Zhejiang Medical Journal

基　　金：浙江省中医药科学研究基金项目资助(2022ZB381)。

摘　　要：目的 比较载万古霉素骨水泥与负压封闭引流(VSD)治疗慢性创伤性骨髓炎的临床疗效。方法 选取2020年1月至2023年3月在舟山市中医院首次诊断为慢性创伤性骨髓炎的31例患者,按随机数字表法分为骨水泥组16例(采用载万古霉素骨水泥治疗)和VSD组15例(采用VSD治疗)。术后比较两组患者疗效及病灶组织或分泌物菌种类型和培养转阴时间;术后1个月比较CRP、ESR;术后1年比较复发情况。结果 骨水泥组治愈10例,好转5例,切口未愈合1例,总有效率为93.75%。VSD组治愈4例,好转5例,切口未愈合6例,总有效率为60.00%,差异有统计学意义(P<0.05)。骨水泥组细菌培养转阴时间为(12.25±4.78)d,显著短于VSD组的(17.27±7.42)d,差异有统计学意义(P<0.05)。骨水泥组革兰阳性菌感染7例,革兰阴性菌感染5例,混合菌感染4例。VSD组革兰阳性菌、革兰阴性菌、混合菌感染例数分别为6、7、2例,两组比较差异均无统计学意义(均P>0.05)。术后1个月骨水泥组CRP为(15.25±4.49),ESR为(17.31±5.23),VSD组CRP为(21.27±3.84),ESR为(28.53±4.27),差异均有统计学意义(均P<0.05)。术后1年骨水泥组复发1例,VSD组复发4例,差异有统计学意义(P<0.05)。结论 相比VSD治疗,载万古霉素骨水泥治疗慢性创伤性骨髓炎有效率高,值得临床推广应用。Objective To compare the clinical efficacy of vancomycin-loaded bone cement and vacuum sealing drainage(VSD) in the treatment of chronic traumatic osteomyelitis.Methods Thirty one patients with chronic traumatic osteomyelitis admitted at Zhoushan Hospital of Traditional Chinese Medicine between January 2020 and March 2023 were randomly assigned to two groups,16 patients were treated with vancomycin-loaded bone cement(bone cement group) and 15 cases were treated with VSD(VSD group).The WBC,ESR,CRP,total surgical efficacy,recurrence,bacterial culture negative-transversion time and bacterial types were compared between the two groups.Both groups were followed up for a year,and their curative effects were compared too.Results The CRP and ESR levels of the bone cement group were significantly lower than those of the VSD group(15.25±4.49 vs.21.27±3.84,P<0.05 and 17.31±5.23 vs.28.53±4.27,P<0.05) at one month after the operation.In the bone cement group,10 cases were cured,5 cases improved and 1 case was not healed with a total effective rate of 93.75%;in the VSD group,4 cases were cured,5 cases improved,and 6 cases were not healed with a total effective rate of 60.0%(P<0.05).There was 1 case of recurrence in the bone cement group and 4 cases in the VSD group(P<0.05).The bacterial culture negative-transversion time in the bone cement group was shorter than that in the VSD group [(12.25±4.78) d vs.(17.27±7.42) d,P<0.05].The bone cement group had 7 cases of Gram-positive bacteria,5 cases of Gram-negative bacteria,and 4 cases of mixed bacterial infections;while the VSD group had 6 cases of Gram-positive bacteria,7 cases of Gram-negative bacteria,and 2 cases of mixed bacterial infections.Conclusion Compared to VSD,the vancomycin-loaded bone cement is more effective in treatment of chronic traumatic osteomyelitis,which is worth of clinical application.

关 键 词：抗生素骨水泥 万古霉素 慢性创伤性骨髓炎 

分 类 号：R687.3[医药卫生—骨科学]