载万古霉素硫酸钙人工骨和骨水泥治疗心脏术后慢性胸骨骨髓炎 1例并文献回顾

目的 探讨载万古霉素硫酸钙人工骨和骨水泥治疗心脏术后慢性胸骨骨髓炎的临床疗效.方法 采用载万古霉素硫酸钙人工骨和骨水泥治疗1例心脏术后慢性胸骨骨髓炎病人.结果 病人经治疗后窦道封闭,创面愈合.术后1年随访,术后胸骨骨髓炎未复发.结论 载万古霉素硫酸钙人工骨和骨水泥是治疗胸骨慢性骨髓炎的一种新方法,值得临床进一步应用和研...     

载药磷酸钙人工骨治疗慢性骨髓炎

随着抗生素的应用及外科技术的进步，慢性骨髓炎发病率已明显下降，然而，慢性骨髓炎的治疗问题仍然具有挑战性。我们自2001年9月-2003年2月，采用载万古霉素的磷酸钙人工骨治疗慢性骨髓炎11例，随访1～2．5年，平均1．6年，结果显示疗效满意，报告如下。     

万古霉素骨水泥治疗胫骨慢性骨髓炎

[目的]回顾应用骨水泥治疗胫骨慢性骨髓炎的临床疗效。[方法]根据条件选取51例患者,将患者分为骨水泥治疗组和冲洗吸引组。其中骨水泥治疗组24例,在骨髓炎病灶清除后应用万古霉素骨水泥填充髓腔;冲洗吸引组27例,清创后在骨髓腔内置管实施冲洗吸引治疗。[结果]所有患者骨髓炎致病菌均为金黄色葡萄球菌,无万古霉素耐药菌株。冲洗吸引组中有1例引流管堵塞提前拔除,但未发生骨髓炎复发,所有患者均顺利康复,骨水泥治疗组住院天数较少,与冲洗组相比差异有统计学意义(P<0.05)。[结论]两种治疗方法均能够较好地治疗骨髓炎,应用骨水泥填塞治疗胫骨骨髓炎住院时间更短,可优先考虑使用。     

耐药金黄色葡萄球菌骨髓炎的治疗

在骨髓炎的致病菌中,耐药金黄色葡萄球菌已经逐渐成为一类很常见的病原菌,给临床治疗带来了很大困难,常常需要联合应用外科治疗和选择细菌敏感的抗菌药物治疗。应用局部载药系统治疗具有一定的优势,高压氧则具有间接治疗作用。     

混合骨载药治疗慢性骨髓炎

目的　探讨应用自体骨、人工骨及抗生素混合材料植入治疗慢性骨髓炎的疗效。方法　通过手术，摘除死骨，清理死腔将混合材料植入，消灭死腔，利用骨的诱导和再生原理及抗生素的缓慢释放，促进骨愈合。结果　本组15例患者，除1例外，其余14例愈合良好。结论　采用本术式治疗慢性骨髓炎，病程短、治愈率高、复发率低。     

载药自固化磷酸钙人工骨治疗慢性骨髓炎

目的 探讨载药自固化磷酸钙人工骨（CPC）治疗慢性骨髓炎的临床疗效.方法 自2002年1月起,对8例慢性骨髓炎患者,行彻底清创后,一期植入载药自固化磷酸钙人工骨.结果 本组均获随访,随访时间为11～35个月,平均21.3个月,1例发生术后伤口表浅感染,随访期间均无骨髓炎复发,未见明显的全身反应,无再骨折,X线片显示,术后骨髓炎区被CPC充分填塞,随访时CPC部分降解成骨.结论 在病灶清除后,一期将载药自固化磷酸钙人工骨植入残留的感染性骨缺损是治疗慢性骨髓炎的较理想的方法.     

一期病灶清除载药磷酸钙人工骨充填治疗慢性骨髓炎

目的 探讨一期病灶清除载药磷酸钙人工骨(CPC)充填治疗慢性骨髓炎的临床疗效:方法 22例慢性骨髓炎患者行彻底清创后,一期植入载药CPC.结果 22例获随访(26.3±6.5)个月,患者术后均未出现过敏或毒性反应,无皮疹或高热;随访期间均无骨髓炎复发.未见明显的全身反应,无再骨折;X线片显示植入CPC与宿主骨接触紧密,界面处未见间隙存在,骨缺损处的解剖形状完全或大部分恢复,未见脱落现象,随访期内18例患者CPC部分降解成骨.结论 在病灶清除后,载药CPC一期充填残留的感染性骨缺损治疗慢性骨髓炎可有效控制感染.     

万古霉素骨水泥治疗骨髓炎的临床疗效分析

目的探讨万古霉素骨水泥治疗骨髓炎的方法及疗效。方法 2008年6月至2011年8月使用万古霉素骨水泥治疗骨折术后骨髓炎的病例12例,男9例,女3例;年龄21～50岁,平均37.3岁。其中股骨4例,肱骨2例,锁骨2例,胫骨4例。以上病例均为术后感染,病程最早为3天,最晚为6个月。术前均常规行伤口及窦道分泌物细菌培养＋药敏,其中7例细菌培养阳性。手术行伤口扩创,窦道切除,术中取病灶细菌培养＋药敏,植入万古霉素骨水泥,比例为1∶20,术后常规行伤口负压引流,全身使用敏感抗生素或万古霉素治疗。分别于术后3 d、1周、2周、6周行血沉、C反应蛋白、血常规检查。结果所有病例均获得随访,随访时间3～14个月。所有患者骨髓炎均得到有效控制,骨折均得到愈合,7例患者行2次手术取出骨折固定物。结论万古霉素骨水泥能有效的治疗术后骨髓炎,控制感染。方法简单、效果可靠,是临床治疗骨折术后感染的有效方法。     

载抗生素硫酸钙结合自体骨Ⅰ期植骨治疗慢性跟骨骨髓炎

目的：探讨清创后伴有骨缺损的慢性跟骨骨髓炎的治疗方法及其疗效.方法：自2009年6月至2011年6月,采用载抗生素硫酸钙结合自体骨Ⅰ期植骨的方法治疗52例慢性跟骨骨髓炎患者,其中男40例,女12例;年龄18～67岁,平均43岁;右侧32例,左侧20例;病程6个月～3年.皮肤软组织缺损面积3.0 cm×1.5 cm～23.0 cm×12.0 cm.按照Cierny-Mader分类法：Ⅲ型34例,Ⅳ型18例.观察治疗后感染控制情况、人工骨吸收及骨缺损修复愈合情况,并采用Maryland评分标准对足跟功能恢复程度进行评价.结果：52例患者均获得随访,时间2～3.8年,平均2.8年.所有患者Ⅰ期治愈,其中2例患者分别于术后3、5个月复发,经再次手术治愈.骨缺损修复愈合时间为1.5～3.5个月,平均2.5个月.人工骨在影像学上完全吸收时间为1.2～3个月,平均2.2个月,10例拔管后存在局部渗出窦道,2～3个月愈合,与人工骨完全吸收时间一致.4例患者皮瓣、肌皮瓣修复术后皮瓣出现部分坏死,经治疗后创面均获得闭合修复.术后Maryland评分为88.15±7.70,优32例,良14例,可6例.结论：应用载抗生素硫酸钙结合自体骨Ⅰ期植骨治疗慢性跟骨骨髓炎可获得满意的临床结果,长期结果需要进一步随访,同时人工骨渗出及其影响因素也需进一步研究.     

抗生素人工骨植入治疗儿童急性血源性骨髓炎

[目的]对比抗生素人工骨植入与减压引流治疗儿童急性血源性骨髓炎的临床疗效.[方法]将本科2010年6月～2019年10月收治的37例确诊并接受手术治疗的儿童急性血源性骨髓炎患者纳入研究,20例患儿接受抗生素人工骨治疗,17例患儿接受减压引流治疗;比较两组治疗费用、术后住院时间、插管天数、体温恢复正常天数、白细胞、C-反...     

Treatment of experimental osteomyelitis with antibiotic-impregnated bone graft substitute

The model of Norden was used to induce osteomyelitis in the left tibia of New Zealand White rabbits. Twenty-one days following inoculation, the animals had primary debridement and then were randomized into one of three treatment groups. Group I received no additional treatment; in Group II, plain hydroxyapatite beads were packed into the defect; and in Group III, gentamicin crobefat-loaded hydroxyapatite beads were packed into the defect. The animals were observed for 40 days after the primary debridement and then were killed. The intensity of infection was determined by swab cultures and quantitative bacterial cultures of the debrided material. At primary debridement, all of the animals in each group were equally infected. At the time of secondary debridement, only the animals in Group III had a statistically significant reduction in infection (p < 0.001). In this study, we demonstrated that an antibiotic-loaded osteoinductive ceramic bead can effectively eliminate bacteria from an osteomyelitic cavity.     

In vivo evaluation of calcium sulfate as a bone graft substitute for lumbar spinal fusion

BACKGROUND CONTEXT: Posterolateral fusions of the lumbar spine have nonunion rates as high as 35%. The availability of autologous bone to promote fusion is limited, particularly for multilevel fusions. Bone substitutes have been proposed to augment or replace autologous bone for spinal surgery. Calcium sulfate offers high porosity, osteoconductivity, and high resorption rate. This material has been used successfully for treatment of long bone defects but has not been investigated as a bone graft substitute for spinal fusions. PURPOSE: To determine whether the use of calcium sulfate granules in conjunction with an implantable electrical stimulator is a safe and effective means of attaining spinal fusion. STUDY DESIGN/SETTING: A rabbit lumbar fusion model was used to assess a calcium sulfate bone graft substitute in combination with electrical stimulation for spinal fusion. METHODS: Thirty-six adult New Zealand White female rabbits were divided into three groups. Each group underwent a single-level (L5-L6) fusion, receiving 3.0 cc calcium sulfate granules with bone marrow aspirate from the iliac crest. Group 1 had no electrical stimulator applied. Groups 2 and 3 received a 40-microA (Group 2) or a 100-microA (Group 3) implantable electrical stimulator. The animals were sacrificed at 8 weeks, and the rabbit spines were subjected to radiographic assessment, manual palpation, and mechanical testing. RESULTS: Two rabbits died postoperatively. The radiographic assessment revealed no fusions occurred at the adjacent nonoperated control levels (L4-L5). There were no fusions observed within Group 1, containing the calcium sulfate and bone marrow aspirate alone. The sites with the implantable stimulators showed a dose-dependent increase in fusion stiffness. However, no fusion mass in Group 2 or 3 was graded as bilaterally complete. CONCLUSION: This study found that calcium sulfate as a bone graft substitute was unsuccessful in promoting spine fusion in a rabbit model. There was radiographic evidence of rapid resorption of the calcium sulfate within 4 weeks after surgery. The use of electrical stimulation created a dose-dependent increase in mechanical competence of the bony mass. However, the addition of direct current (DC) current did not significantly alter fusion rates with calcium sulfate used as the bone graft substitute in this model.     

Response of a calcium sulfate bone graft substitute in a confined cancellous defect

Calcium sulfate, plaster of Paris, has a long clinical history for use as a bone graft substitute in various skeletal sites. The current authors examined the in vivo response of calcium sulfate pellets alone or in combination with autogenous bone graft in a bilateral critical-size distal femoral cancellous defect in an adult sheep model. New thick bone formation was seen in defects filled with calcium sulfate pellets alone. Increased immunostaining for bone morphogenetic protein-2, bone morphogenetic protein-7, transforming growth factor-beta, and platelet derived growth factor was seen in defects filled with calcium sulfate pellets alone and in combination with autograft. The local acidity during calcium sulfate resorption is proposed as a possible in vivo mechanism for this type of material.     

The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial

In a prospective, nonrandomized, multicenter study, 109 patients with bone defects were treated with a surgical grade calcium sulfate preparation as a bone graft substitute. The calcium sulfate pellets were used in place of morselized cancellous bone graft for the treatment of patients with bone defects who usually would require grafting secondary to trauma, periprosthetic bone loss, tumor, or fusion. The calcium sulfate was used alone or mixed with other materials such as bone marrow aspirate, demineralized bone matrix, or autograft. The defects that were treated were contained and were not necessary for the stability of the bony structure. Radiographic and clinical data were collected at predetermined intervals for 12 months. At 6 months postoperatively, radiographic results for all patients showed that 99% of the calcium sulfate had been resorbed and 88% of the defect was filled with trabeculated bone. There were 13 complications; however, only four (3.6%) were attributable to the product. The results of a subgroup of 46 patients with benign bone lesions treated in the same manner are identical to the results of the overall study population. Surgical grade calcium sulfate pellets are considered a convenient, safe, and readily available bone graft substitute that yield consistent successful results.     

Calcium sulfate used as bone graft substitute in acetabular fracture fixation

The purpose of this study was to determine the natural history of calcium sulfate pellets implanted during acetabular fracture surgery. The study group consisted of patients sustaining an acetabular fracture with intraarticular comminution or marginal impaction or both in whom calcium sulfate pellets were implanted in lieu of autologous bone graft. Between 1997 and 1999, 32 fractures were treated. Followup adequate to delineate pellet outcome, including radiographs and computed tomography, was obtained in 31 patients. Evaluation of plain radiographs showed that the calcium sulfate pellets became undifferentiated from the surrounding bone at an average of 7 weeks postoperatively. In no case was a residual bony deficit seen. Computed tomography analysis showed that in 22 patients, the pellets essentially had been (> 90%) replaced by bone and in four patients, the majority (> 50%-90%) of the pellets had been replaced by bone. However, in five patients, less than 50% of the pellets had been replaced by bone, including one showing no bony replacement. The common finding in patients with an extensive residual deficit was direct communication of the pellets with the joint space shown on the postoperative computed tomography scan. Patients with the best results had complete containment of the pellets within bone. Therefore, it seems that implanted calcium sulfate pellets in contact with joint synovial fluid are at risk for resorption without significant bony response. If calcium sulfate pellets are to be implanted in a periarticular location, complete bony containment is desirable. Evaluation of the periacetabular bony response requires computed tomography scans, as plain radiographs are inadequate for this purpose.     

脉冲冲洗加负压封闭引流及开放植骨治疗慢性骨髓炎

<正>慢性骨髓炎是有伤口的骨感染超过6周者,大多数是因急性骨髓炎治疗不当或不及时引起,手术失败率、感染复发率高,治疗周期长且易复发,是临床骨科治疗的难题。传统的治疗手段为至少4～6周静脉抗生素应用及局部清创冲洗或肌皮瓣堵塞治疗,但常难以彻底消除感染。2005年至2009年采用脉冲冲洗加负压封闭引流(vacuum sealing drainage,VSD)并开放植骨治疗慢性骨髓炎,现报告如下。     

Tricalcium phosphate as a bone graft substitute

A clinical trial is reported that was conducted in an attempt to establish a timeframe for replacement of tricalcium phosphate by bone. In 20 cases, an 8.5mm by 3mm disc of tricalcium phosphate was implanted into the cut surface of the tibia at the time of total knee replacement. When followed radiographically, the disc of tricalcium phosphate generally could not be identified at six months. At two years, no untoward effects have occurred and no vestigial shadows remain, indicating that the block has fully incorporated and largely been absorbed and replaced by host bone. The experience in this series of cases indicates that tricalcium phosphate is a useful resorbable bone filler material.     

Treatment of nonunions and osseous defects with bone graft and calcium sulfate

The treatment of long bone nonunions and fractures with osseous defects is challenging. The results of 26 patients with either a persistent long bone nonunion or an osseous defect after an open fracture were reviewed. Each patient was treated with debridement of devitalized tissue, open reduction and internal fixation, and bone grafting using a mixture of autogenous iliac crest bone graft and medical grade calcium sulfate. The current study evaluated the union rate and associated complications for treatment of these injuries using this protocol. Each nonunion was confirmed intraoperatively, and healing was determined clinically by the patients' return to full activities without pain and radiographically by the presence of bridging trabeculae. Complications included persistent nonunion (four patients), wound drainage (five patients), wound drainage and cellulitis (one patient) and cellulitis alone (one patient). Using this treatment protocol, 22 patients (85%) achieved healing after one surgery and an additional two patients (92%) achieved healing after a second surgery. Medical grade calcium sulfate increases the volume of graft material, facilitates bone formation, and is safe in the treatment of nonunions and fractures with osseous defects.     

Local and systemic levels of tobramycin delivered from calcium sulfate bone graft substitute pellets

We asked if tobramycin-loaded calcium sulfate pellets could be used to maintain high local site antibiotic concentrations for an extended period with minimal systemic levels and without adverse effects on vital organs. Calcium sulfate pellets loaded with 10% tobramycin were implanted in contained medullary defects in the proximal humeri of canines. The number of pellets implanted was calculated to yield an equivalent human maximum prescribed dose, and 1.8-fold this dose. These doses converted to approximately 20 mg/kg, and 36 mg/kg, respectively, for the canine. Local and systemic tobramycin levels, pellet resorption, bone response, clinical pathology parameters, and histopathologic responses of potential target organs were analyzed to determine if there was any adverse response for a 28-day period. Serum tobramycin was elevated for less than one day while local levels remained elevated for at least 14 days, and in some animals, 28 days. Tobramycin delivered locally from calcium sulfate pellets had no apparent adverse effect on clinical pathology parameters or on any of the organs that were analyzed. In addition, bone formation and pellet resorption followed patterns typically seen with calcium sulfate materials.     

Successful treatment of chronic osteomyelitis in children with debridement,antibiotic-laden cement spacer and bone graft substitute

Purpose

Chronic osteomyelitis and infected nonunion are relatively rare conditions in pediatric patients and are more frequently seen in developing countries. Although relatively rare, they are medically and surgically challenging. Here we report a novel surgical technique used to manage five patients with chronic osteomyelitis of long bones.

Methods

Five skeletally immature patients with chronic osteomyelitis and infected nonunion of the long bones were treated surgically between 2010 and 2014 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, and application of antibiotic-laden cement spacer inducing periosteal membrane before final bone reconstruction. Once inflammatory markers normalized, all the patients were re-operated for cement removal, bone graft substitution, and concomitant osteosynthesis of the affected bone, if needed. All patients underwent MRI, CT scan, and laboratory evaluation prior to surgery. The antibiotic regimen was started empirically and then adjusted according to culture and sensitivity results.

Results

Mean patient age at the time of diagnosis was 11 years (range 4–14), and all patients had at least 2-year follow-up (range 2–5). At last follow-up, clinical and laboratory evaluation had normalized, the bone had healed, and all patients had resumed daily living and sports activities.

Conclusion

Surgical debridement is the standard approach to chronic osteomyelitis. Use of antibiotic-laden cement is recommended to penetrate local infection, with antibiotic therapy playing an adjunctive role. The cement also induces membrane formation that aids bone reconstruction.

Level of evidence

IV.