载万古霉素骨水泥间隔器治疗跟骨创伤后骨感染的疗效
Efficacy of vancomycin cement spacer for bone infection after calcaneal fracture
目的 探讨载万古霉素骨水泥间隔器治疗跟骨创伤后骨感染的临床疗效.方法 采用回顾性病例系列研究分析2012年2月-2016年8月陆军军医大学第一附属医院骨科收治的31例跟骨创伤后骨感染患者临床资料,其中男24例,女7例;年龄20~59岁,平均43岁.左足11例,右足17例,双侧3例.2例伴有皮肤软组织缺损.骨感染持续时间为0.25~40年,平均6.5年.均采用彻底清创后,万古霉素骨水泥间隔器填充骨缺损治疗,6~8周后可采用自体骨植骨恢复肢体重建.比较术前术后白细胞计数(WBC)、红细胞沉降率(ESR)、C-反应蛋白(CRP)及白细胞介素-6(IL-6),观察患肢临床表现(红肿热痛及窦道形成)、X线片(侧位及轴位片)及骨感染控制情况.采用美国足踝外科协会后足(AOFAS-AH)评分评估患者术后患肢功能,并观察伤口愈合及并发症情况.结果 患者均获随访14~42个月,平均20.5个月.术后1个月WBC由术前(10.9±5.2)×109/L降至(8.4±2.7)×109/L,ESR由术前(27.5±25.5) mm/h降至(6.21±3.20) mm/h,CRP由术前(11.4±9.3)mg/L降至(3.3±1.8) mg/L,IL-6由术前(7.3±5.2) ng/L降至(4.3 ±2.2) ng/L(P均<0.05).术后1,3,6,12个月定期复查X线片示骨水泥位置良好.3例术后患肢出现窦道并再次接受万古霉素骨水泥间隔器治疗后未再复发.骨感染治愈率为91%(28/31).AOFAS-AH评分由术前(38.4 ±3.7)分改善为术后1个月时(50.2 ±7.4)分及术后6个月时(65.5±2.9)分(P<0.05).4例术后足部疼痛,给予自体骨植骨后缓解.所有患者于术后0.5~3个月(平均1.5个月)伤口获得愈合.结论 采用万古霉素骨水泥间隔器能够有效治疗跟骨创伤后骨感染,术后可自体骨植骨,能促进伤口愈合及保存患肢功能,是治疗跟骨创伤后骨感染简单、有效的方法.
更多Objective To investigate the clinical efficacy of vancomycin cement spacer in the treatment of bone infection after calcaneal fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with bone infection after calcaneal fracture admitted to First Affiliated Hospital of Army Medical University from February 2012 to August 2016.There were 24 males and seven females,aged 20-59 years,with an average of 43 years.There were 11 patients with infection at the left foot,17 patients at the right foot,and three patients at both feet.Two patients were accompanied with skin and soft tissue defects.The duration of bone infection was 0.25-40 years,with an average of 6.5 years.After thorough debridement,the vancomycin cement spacer was used to fill the bone defect.Limb reconstruction with autogenous bone graft was performed after 6-8 weeks.After the operation,white blood cell count (WBC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) and interleukin-6 (IL-6) were recorded.The clinical manifestations of the affected limb (redness,swelling,heat,pain and sinus formation) and X-ray films (lateral position and axial position) were observed.The American Foot and Ankle Surgery Association's hind foot (AOFAS-AH) score was used to assess the postoperative limb function.Wound healing and complications were recorded.Results The patients were followed up for 14-42 months,with an average of 20.5 months.At postoperative 1 month,WBC was decreased from preoperative (10.9 ± 5.2) × 109/L to (8.4 ± 2.7) × 109/L,and ESR decreased from preoperative (27.5 ±25.5)mm/h to (6.21 ±3.20)mm/h,CRP decreased from preoperative (11.4 ± 9.3) mg/L to (3.3 ± 1.8) mg/L,and IL-6 decreased from preoperative (7.3 ± 5.2) ng/L to (4.3 ± 2.2) ng/L (all P < 0.05).Three patients who had sinus after operation received vancomycin cement spacer treatment for a second time and were not seen relapse of sinus afterwards.The cure rate of bone infection was 91% (28/31).X-ray films were regularly reviewed at 1,3,6,and 12 months after surgery and showed good bone cement position.Sinus tract appeared in the affected limbs of three patients after operation,and no recurrence was found after the vancomycin cement spacer treatment again.The cure rate of bone infection was 91% (28/31).The AOFAS-AH score improved from preoperative (38.4 ± 3.7) points to (50.2 ± 7.4) points at postoperative 1 month and to (65.5 ± 2.9) points at postoperative 6 months (P < 0.05).Four patients with postoperative foot pain received autologous bone grafting and the pain was relieved.All patients were seen with wound healing at postoperative 0.5-3 months (mean,1.5 months) and returned to work.Conclusions The vancomycin cement spacer is a simple and effective method for bone infection after calcaneal fracture.Autologous bone grafting can be performed after the operation,which can promote wound healing and preserve limb function.
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