耐甲氧西林金黄色葡萄球菌感染的四肢创伤性骨髓炎的手术治疗

目的： 总结并探讨采用利奈唑胺静滴联合万古霉素局部靶向缓释治疗耐甲氧西林金黄色葡萄球菌（dumethicillin-resistant Staphylococcus aureus，MRSA）感染的四肢创伤性骨髓炎的临床疗效及应用价值。方法： 回顾分析2015年3月至2017年3月在我院就诊的MRSA感染的四肢创伤性骨髓炎30例，其中男21例，女9例；年龄25~64（47.94±6.23）岁；病程9~23（15.68±6.23）个月。病灶部位：胫骨18例，跟骨12例。致伤原因：摔伤12例，车祸伤9例，坠落伤9例。闭合性骨折22例，开放性骨折8例。存在内固定13例。22例存在窦道，8例存在一定范围的软组织缺损伴骨及内固定外露，软组织缺损面积2.0 cm×3.0 cm~8.2 cm×12.3 cm；10例存在骨缺损，缺损范围0.5~3.4 cm；所有患者窦道或创面分泌物细菌培养均为MRSA。所有病例在彻底清创的基础上，病灶处植入载万古霉素硫酸钙人工骨，同时在围手术期静滴利奈唑胺葡萄糖注射液。术后从抗生素使用时间，血常规、红细胞沉降率、超敏C反应蛋白及肝肾功能等相关实验室指标，X线片、CT等影像学检查，骨质愈合、皮瓣成活、关节功能等情况以及根据McKee等骨髓炎治愈标准进行定期随访评价。结果： 所有患者获随访，时间3~6（4.23±0.76）年，均未出现骨髓炎复发情况，实现了骨折愈合、感染控制、创面愈合、功能恢复。结论： 利奈唑胺静滴联合万古霉素局部靶向缓释治疗MRSA感染的四肢创伤性骨髓炎的疗效显著，复发率低。

Surgical treatment of traumatic osteomyelitis of extremities with MRSA infection

Objective: To summarize and discuss the clinical efficacy and application value of intravenous drip of linezolid combined with local targeted sustained-release of vancomycin in the treatment of traumatic osteomyelitis of extremities infected with MRSA.Methods: Thirty patients with traumatic osteomyelitis of extremities infected by MRSA from March 2015 to March 2017 were analyzed retrospectively,including 21 males and 9 females; aged 25 to 64 years old,with an average age of(47.94±6.23) years old;the course of disease ranged from 9 to 23 months,with an average of(15.68±6.23) months. The lesions were located in tibia in 18 cases and calcaneus in 12 cases. The causes of injury were fall injury in 12 cases,traffic accident injury in 9 cases and fall injury in 9 cases. There were 22 patients with closed fractures and 8 patients with open fractures. There were 13 cases of internal fixation. Twenty-two patients had sinus tract,8 patients had soft tissue defect with bone and internal fixation exposure,soft tissue defect area ranged from 2.0 cm×3.0 cm to 8.2 cm×12.3 cm;10 patients had bone defect,defect area ranged from 0.5 to 3.4 cm;bacterial culture of sinus tract or wound secretion in all patients was MRSA. On the basis of thorough debridement,calcium sulfate artificial bone loaded with vancomycin was implanted in the lesion,and linezolid and glucose injection was given intravenously during the perioperative period. The patients were followed up regularly according to the time of antibiotic use,blood routine,erythrocyte sedimentation rate,high-sensitivity C-reactive protein,liver and kidney function and other related laboratory indexes,X-ray,CT and other imaging examinations,bone healing,flap survival,joint function and McKee''s osteomyelitis cure criteria.Results: All the patients were followed up,and the duration ranged from 3 to 6 years,with a mean of (4.23±0.76) years. No recurrence of osteomyelitis occurred. Fracture healing,infection control,wound healing and functional recovery were achieved.Conclusion: Intravenous drip of linezolid combined with local targeted sustained-release of vancomycin for the treatment of MRSA infected traumatic osteomyelitis in limbs have significant effects and low recurrence rates.