采用抗生素骨水泥治疗糖尿病患者心脏术后胸骨骨髓炎的临床效果观察  

Clinical effect of antibiotic bone cement in the treatment of sternal osteomyelitis after cardiac surgery for patients with diabetes mellitus

作　　者：徐志刚 曹涛 何亭 李博奥 魏婧韬 张栋梁 官浩 杨薛康 Xu Zhigang;Cao Tao;He Ting;Li Boao;Wei Jingtao;Zhang Dongliang;Guan Hao;Yang Xuekang(Department of Burn and Skin Surgery,Burn Center of PLA,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心烧伤与皮肤外科,西安710032

出　　处：《中华损伤与修复杂志（电子版）》2024年第6期498-502,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金(81901980);陕西省自然科学基金(2020JM-332);陕西省重点研发计划项目(2022SF-025、2021SF-107、2021SF-341)。

摘　　要：目的探讨采用抗生素骨水泥治疗糖尿病患者心脏术后胸骨骨髓炎的临床效果。方法2019年3月至2023年2月,空军军医大学第一附属医院烧伤与皮肤外科收治符合纳入与排除标准的心脏外科开胸术后发生胸骨骨髓炎的糖尿病患者23例,对其临床资料进行回顾性分析。患者入院后首先行创面分泌物细菌培养,一期术中彻底清创后填充抗生素骨水泥,2~4周后待创面无明显渗出,再次手术取出骨水泥,沿深筋膜层充分游离伤口两侧软组织形成皮肤筋膜瓣,两侧皮肤筋膜瓣直接拉拢缝合修复。结果23例患者中21例创面一期愈合,随访半年无复发;1例拆线后伤口裂开约1 cm,门诊换药7 d后愈合;1例出院1个月后伤口再次破溃形成窦道,再次入院按此方法治疗后痊愈。结论抗生素骨水泥是治疗糖尿病患者心脏术后胸骨骨髓炎的有效方法。Objective To investigate the clinical effect of antibiotic bone cement in the treatment of sternal osteomyelitis after cardiac surgery for patients with diabetes mellitus.Methods The clinical data of 23 diabetes mellitus patients with sternal osteomyelitis after cardiac surgery admitted to the Department of Burn and Skin Surgery,the First Affiliated Hospital of Air Force Medical University from March 2019 to February 2023 were retrospectively analyzed.All patients underwent bacterial culture of wound secretions.The antibiotic bone cement was filled after thorough debridement in one-stage operation.After 2 to 4 weeks,when there was no obvious exudation from the wound surface,the bone cement was taken out again,and the soft tissue on both sides of the wound was fully freed along the deep fascia layer to form a skin fascia flap,and the skin fascia flap on both sides were directly sutured.Results Among the 23 patients,the wound of 21 patients healed by first intention and no recurrence was found after a six-month follow-up.The wound of one patient dehisced about 1 cm after taking out the sutures,and healed after 7 days of dressing change.The wound of one patient ruptured again and formed sinus one month after discharge,and recovered after readmission.Conclusion The use of antibiotic bone cement is an effective method to treat sternal osteomyelitis after cardiac surgery in patients with diabetes mellitus.

关 键 词：胸骨骨髓炎 糖尿病 骨水泥 抗生素 创面修复 

分 类 号：R587.1[医药卫生—内分泌]