Ilizarov骨搬移技术联合抗生素骨水泥治疗胫骨感染相关慢性骨髓炎的疗效  

Effectiveness of antibiotic-loaded bone cement combined with Ilizarov bone transfer technique on treatment of patients with chronic osteomyelitis caused by tibial infection

作　　者：杜炯 何旻颖 高宁阳 郑昱新 詹红生 DU Jiong;HE Min-ying;GAO Ning-yang;ZHENG Yu-xin;ZHAN Hong-sheng(Shanghai Shuguang Hospital,Shanghai 20002l,China)

机构地区：[1]上海曙光医院骨伤科,上海200021

出　　处：《中华医院感染学杂志》2024年第23期3581-3585,共5页Chinese Journal of Nosocomiology

基　　金：上海市科技计划项目(20MC1920600)。

摘　　要：目的分析抗生素骨水泥对胫骨感染相关慢性骨髓炎患者血清转化生长因子-β1(TGF-β1)、Smad3、γ-干扰素诱生蛋白10(IP-10)、骨形态发生蛋白-2(BMP-2)水平的影响。方法选取2021年6月—2023年6月上海曙光医院收治的胫骨感染相关慢性骨髓炎患者98例为研究对象,采用随机数字表法分为Ilizarov骨搬移技术治疗的A组和在A组治疗的基础上联合抗生素骨水泥治疗的B组,每组49例,术后均观察6周,随访3个月,统计患者术后恢复及复发情况,比较两组治疗前后血清细胞因子水平、炎症指标水平及疼痛情况。结果B组患者伤口复原时间、拆线时间、骨吸收时间及住院时间均短于A组(P<0.05);B组治疗总有效率(91.84%)高于A组(73.47%)(χ~2=5.765,P=0.016);治疗后6周,两组TGF-β1、Smad3、BMP-2水平与治疗前比较均升高(P<0.05),B组高于A组(P<0.05);IP-10、白细胞计数(WBC)、中性粒细胞(NEU)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平与治疗前比较均降低(P<0.05),B组低于A组(P<0.05);治疗后2、6周及随访3个月,两组患者疼痛评分呈降低趋势(F=205.378、342.284,P均<0.001),B组疼痛评分低于A组(P<0.05)。结论抗生素骨水泥联合Ilizarov骨搬移技术治疗胫骨感染相关慢性骨髓炎患者,可有效改善其血清TGF-β1、Smad3、IP-10、BMP-2水平,降低机体炎症反应和疼痛,有助于患者病情控制和术后恢复,具有较好的临床疗效,且有助于预防术后复发。OBJECTIVE To analyze the effectiveness of antibiotic-loaded bone cement on serum transforming growth factor-β1(TGF-β1),Smad3,-interferon inducible protein-10(IP-10)and bone morphogenetic protein-2(BMP-2)in patients with chronic osteomyelitis caused by tibial infection.METHODS From Jun.2021 to Jun.2023,totally 98 patients with chronic osteomyelitis caused by tibial infection in Shanghai Shuguang Hospital were enrolled and divided into group A treated with Ilizarov bone transfer technique and group B treated with additional antibioticbased bone cement through computer-generated table of random numbers with 49 cases in each group.All patients were observed for 6 weeks after operation and followed up for 3 months.The post-operative recovery and recurrence were statistically analyzed,and the pre-and post-operative serum profiles of cytokines,inflammatory indicators and pain conditions were compared between the two groups.RESULTS The wound healing time,suture removal time,time for bone absorption and the length of stay in the group B were all shorter than those in the group A(P<0.05).The serum levels of TGF-β1,Smad3 and BMP-2 in the two groups 6 weeks after operation were higher than those before operation(P<0.05),and those in the group B were higher than those in the group A(P<0.05).The serum levels of IP-10,white blood cells(WBC),neutrophils(NEU),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)after operation were lower than those before operation(P<0.05),and those in the group B were lower than those in the group A(P<0.05).The pain assessment scores of group A and B were contrasted at the time point of after 2,6 weeks and 3 months after operation,they showed a decreasing trend in both groups(F=205.378,342.284,P<0.001,respectively),and scores in group B was lower than those in group A(P<0.05).CONCLUSIONS Antibiotic-loaded bone cement combined with Ilizarov bone transfer technique can effectively decrease TGF-βl,Smad3,IP-10 and BMP-2 levels,reduce the inflammatory reaction and pains.It contributes to co

关 键 词：慢性骨髓炎 感染 胫骨 抗生素骨水泥 Ilizarov骨搬移技术 转化生长因子-β1 Smad3 γ-干扰素诱生蛋白10 骨形态发生蛋白-2 

分 类 号：R681.2[医药卫生—骨科学]