载抗生素硫酸钙人工骨治疗股骨髓内钉感染  

Artificial bone loaded with antibiotic calcium sulfate in the treatment of femoral intramedullary nail infection

作　　者：王石林 钟文龙 杨瑞芳 郭再冉 张磊 王新卫 WANG Shi-lin;ZHONG Wen-long;YANG Rui-fang;GUO Zai-ran;ZHANG Lei;WANG Xin-wei(SectionⅠ,Dept of Bone and Joint Infections,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang,Henan 471002,China;Luoyang Work Dept of Degree and Graduate Education,Henan University of Chinese Medicine,Zhengzhou,Henan 450046,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)骨与关节感染一科,河南洛阳471002 [2]河南中医药大学学位与研究生教育洛阳工作部,河南郑州450046

出　　处：《临床骨科杂志》2024年第3期429-433,共5页Journal of Clinical Orthopaedics

基　　金：河南省中医药管理局科技攻关计划项目(编号:182102310487)。

摘　　要：目的探讨载抗生素硫酸钙人工骨治疗股骨髓内钉感染的疗效。方法采用病灶清除+髓内钉取出+载抗生素硫酸钙人工骨填充+外固定架治疗37例股骨髓内钉感染患者。记录红细胞沉降率(ESR)、C-反应蛋白(CRP)、白细胞计数(WBC)以及骨折愈合时间、去除外固定架时间、膝关节AKS评分,采用Tohner-Wrnch标准评价治疗效果。结果患者均获得随访,时间10~15(13.91±0.98)个月。8例清创后骨缺损较大,术后2个月行自体髂骨植骨治疗,均愈合良好。ESR、CRP、WBC术后14 d均较术前改善,差异均有统计学意义(P<0.01)。骨折愈合时间3~7(4.93±0.98)个月,去除外固定架时间6~9(7.35±0.93)个月。末次随访时,膝关节AKS评分由术前70~85(78.53±4.02)分提高至140~153(147.03±4.03)分,差异有统计学意义(P<0.05);采用Tohner-Wrnch标准评价疗效:优25例,良8例,可4例,优良率89.19%。结论载抗生素硫酸钙人工骨治疗股骨髓内钉感染,能有效控制髓内感染,具有良好的生物相容性且能诱导成骨,治疗效果满意。Objective To investigate the therapeutic effect of artificial bone loaded with antibiotic calcium sulfate on femoral intramedullary nail infection.Methods The 37 cases of femoral intramedullary nail infection were treated with lesion removal+intramedullary nail removal+artificial bone loaded with antibiotic calcium sulfate filling plus external fixator.The following data were recorded,including the erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),white blood cell count(WBC),fracture healing time,removal time of the external fixator,AKS score of knee joint,and the therapeutic effect was evaluated by Tohner-Wrnch criteria.Results All patients were followed up for 10~15(13.91±0.98)months.After debridement,8 patients with larger bone defects were performed with autogenous iliac bone grafting at 2 months postoperation,and all cases healed well.ESR,CRP and WBC were improved than preoperation at 14 d after operation,there were all statistical differences(P<0.01).The healing time was 3~7(4.93±0.98)months,and the removal time was 6~9(7.35±0.93)months.At the last follow-up,AKS scores of knee joint were improved from preoperative 70~85(78.53±4.02)points to 140~153(147.03±4.03)points,with statistical significance(P<0.05).Tohner-Wrnch criteria was used to evaluate the curative effect:25 cases were excellent,8 cases were good,4 cases were fair,and the excellent-good rate was 89.19%.Conclusions Artificial bone loaded with antibiotic calcium sulfate can effectively control intramedullary infection,which has good biocompatibility and can induce osteogenesis,with satisfactory effect.

关 键 词：载抗生素硫酸钙人工骨 股骨髓内钉感染 

分 类 号：R681.2[医药卫生—骨科学] R318[医药卫生—外科学]