临床药师参与1例骨髓炎治疗分析

目的：探讨临床药师参与骨髓炎患者治疗中发挥药学服务作用。方法：临床药师通过参与一例特殊骨髓炎患者的治疗过程,结合患者疾病特点、用药史及药品不良反应等情况,建议医师选择合适的药物,提供个体化的药学服务。结果：患者的药物治疗方案安全有效合理。通过临床药师提供个体化药学服务,及时发现和解决了患者药物治疗的问题,为合理有效的治疗方案制定提供了建议。结论：临床药师在为患者提供个体化药学服务方面具有自身的优势,在合理用药中发挥了重要作用。     

Intracortical haematogenous osteomyelitis

We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patient’s blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.     

Coincidence of infectious osteomyelitis and disseminated neuroblastoma: A diagnostic dilemma solved by scintigraphic imaging

Summary The case of a 41/2-year-old girl with disseminated neuroblastoma and concomitant osteomyelitis is reported. Neuroblastoma was detected in the vertebral column, the right suprarenal fossa, the left side of cranium and in bone marrow aspirates. Osteomyelitis was present in the left femur and was due to Salmonella tennessee. For the first time in the literature the two lesions were demonstrated by means of simultaneous ¹³¹I-MIBG and ^99mTc-DPD scintigraphy. The diagnoses were proved by direct histological and microbiological studies.     

Gibbus deformity: Lessons from incompletely treated osteomyelitis

Gibbus deformity is defined by the collapse of one or more vertebral bodies, which results in kyphosis and is often the consequence of infection, metabolic, or congenital irregularities in the vertebrae. In this report we present a unique case of a young male with inadequately treated MRSA bacteremia complicated by lumbar osteomyelitis with progression to severe joint destruction and a marked Gibbus deformity.     

Acute osteomyelitis of the distal fibula in children: Treatment options and long-term follow-up

IntroductionAcute osteomyelitis of the distal fibula is a rare disease in children and is characterized by special features compared with other sites. The objective of this study was to report the functional outcome at long-term follow-up.MethodsWe reviewed retrospectively, between January 2000 and December 2010, all cases of acute osteomyelitis of the distal fibula. Epidemiological and bacteriological data as well as therapy and outcome factors were analyzed. At the last follow-up, functional outcome was studied based on ankle motion, growth disturbance, and radiological sequelae.ResultsSeven cases of acute osteomyelitis of the distal fibula were found. The mean age was patients was 7.71 years and the sex ratio was 2.5. The portal of entry of the pathogen was a skin injury in 57% of cases. Staphylococcus aureus was identified in 71% of cases. The mean duration of antibiotic therapy was 33.2 days. At a mean of 12.85 years of follow-up, no growth disturbance was found. The mean plantar and dorsal flexion was 41° and 27.7°, respectively. The mean postoperative American Orthopedics Foot and Ankle score (AOFAS) was 96.71 points.ConclusionAcute osteomyelitis of the distal fibula in children is scarce and rarely reported in the literature. It occurs more often in boys at an average age of 7 years. Local symptoms are usually more obvious than general symptoms. Surgical debridement of the subperiosteal abscess without bone trepanation seems to lead to a satisfactory outcome.Level of evidenceLevel IV – case series.IRBSahloul Hospital Human Research Ethics Committee.     

腓肠内侧动脉穿支肌瓣治疗胫骨上端创伤性慢性骨髓炎

目的 总结腓肠内侧动脉穿支岛状肌瓣移植治疗胫骨上端创伤性慢性骨髓炎临床应用结果。方法 应用腓肠内侧动脉穿支岛状肌瓣移植治疗胫骨上端创伤性慢性骨髓炎12例（男8例，女4例）。年龄20～58岁（平均32岁）。供区均选用同侧小腿。肌瓣表面行一期中厚网状游离植皮，供区直接缝合。结果 1例术后发生表浅感染，经交换敷料逐渐愈合，肌瓣和其上植皮全部成活，术后经过顺利，术后随访半年～5．5年（平均2．5年），没有发现明显的供区功能障碍。取得了较满意的效果。结论 该肌瓣以腓肠内侧动脉穿支为血供，具有血供丰富，血管解剖恒定，血管蒂长，以及肌瓣较薄的优点，带蒂移植适宜修复胫骨上端慢性骨髓炎。     

聚D,L-乳酸/β-磷酸三钙微管负载左氧氟沙星粉剂治疗慢性骨髓炎的初步疗效观察

目的:初步观察负载左氧氟沙星粉剂的聚D,L-乳酸/β-磷酸三钙(PDLLA/β-TCP)微管治疗慢性骨髓炎的疗效。方法:对20只新西兰兔采用细菌植入法制造慢性骨髓炎模型。2周后对动物病灶取病检,同时对动物进行X光片和螺旋CT检测。在造模成功的慢性骨髓炎模型中,用负载左氧氟沙星粉剂的PDLLA/β-TCP微管填充于缺损处。2周后,对动物进行X光、CT以及病理切片检查。结果:15只动物慢性骨髓炎造模成功,仅12只存活,经负载左氧氟沙星粉剂的PDLLA/β-TCP微管治疗后,有11只治愈。结论:PDLLA/β-TCP复合材料制成的储存式药物载体,可以有效治疗慢性骨髓炎。     

抗感染重组合异种骨对兔胫骨近端骨髓炎的预防作用

目的：探索一种能效预防术后感染,降低骨髓炎发生率,同时能促进骨损伤快速修复的方法。方法：在重组合异种骨（RBX）基础上,结合抗生素缓释技术,研制抗感染重组合异种骨（ARBX）,并进一步采用兔胫骨近端骨髓炎模型,于胫骨近端骨窗内注入金葡菌后即刻,分别植入ARB（ARBX组）,植入RBX并肌注庆大霉素（RBX加全身用药组）,单纯植入RBX（RBX组）,术后8周无菌取材,通过解剖学,放射学,组织学,细菌学检查,比较上述各组方法对骨髓炎的预防作用。结果：术后8周,RBX加全身用药组的细菌计数及改良的Norden分值较RBX组明显减少（P＜0．01）,但ARB组明显增多（P＜0．01）,其解剖学及组织学观察的骨髓炎程度也介于RB组和ARBX组这间,ARB组的细菌计数及改良的X线Norden骨髓炎分值均极低,明显小于其它2组（P＜0．01）,其解剖学和组织学观察均无骨髓炎表现。结论：传统的全身抗生素应用,有一定的抗感染能力,但当I期植骨时,不能有交地发挥预防骨髓炎的作用。ARBX除有良好的骨传导和骨诱导作用外,还有很好的抗生素缓释作用。具有非常强的抗感染能力,能I期植骨修复细菌污染的骨缺损,并能有效预防骨髓炎的发生。     

改良双套管脉冲持续冲洗结合VSD在骨髓炎治疗中的应用

目的：比较分析改良双套管脉冲持续冲洗结合VSD在治疗骨折术后继发骨髓炎的临床应用价值。方法：回顾性分析自2014年1月至2017年1月我院收治的25例骨折术后继发骨髓炎患者资料,行常规病灶清除术后,改良组15例采用双套管脉冲冲洗结合VSD持续引流7天,并与传统组10例持续灌洗引流14天比较,随访6个月。疗效评价指标包括血沉和C反应蛋白水平变化,手术时间,住院时间,换药次数,局部炎症消退时间及复发率等。结果：按上述疗效评定标准,两组患者均一期愈合,均无复发病例,但改良组血沉和C反应蛋白水平在术后7天（P=0.001和P=0.002）、14天（P=0.000和P=0.000）较传统组下降明显。同时改良组在住院时间（P=0.001）,术后换药次数（P=0.000）,局部炎症消退时间（P=0.001）等相较传统组有显著性改善。在手术时间（P=0.646）和复发率上两组比较无明显差异。结论：改良双套管脉冲持续冲洗结合VSD法将可调控的脉冲冲洗技术与VSD技术相结合,能迅速控制炎症,有效促进骨髓炎清创术后的恢复,便于术后管理,是一种值得推广的骨髓炎治疗方法。