负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎的临床研究

目的 :研究负压封闭引流联合负载万古霉素硫酸钙与自体骨在治疗慢性骨髓炎中的疗效。方法 :2013年6月至2016年12月治疗35例慢性骨髓炎患者,男23例,女12例;年龄11~65岁,平均34岁;病程8~46个月,平均26个月。所有患者为开放性创伤导致的慢性骨髓炎,病灶局部有反复红肿及脓液穿破皮肤病史。32例窦道分泌物细菌培养阳性,3例窦道分泌物细菌培养阴性。影像学检查显示病灶存在骨破坏、骨缺损,周围有骨质增生硬化。Ⅰ期行彻底清创,清除病灶坏死及炎性组织,负压封闭引流敷料完全覆盖创面,以促进创面的修复。Ⅱ期将负载万古霉素硫酸钙与自体髂骨松质骨混合为移植骨复合体,均匀填充病灶。观察患者伤口愈合情况,并对病灶进行X线检查,了解硫酸钙吸收及新骨生长情况。结果:26例行1次清创加负压封闭引流,6例行2次清创加负压封闭引流,3例行3次清创加负压封闭引流。32例伤口甲类愈合,2例乙类愈合的患者经抗感染、伤口换药等治疗后伤口完全愈合。1例丙类愈合的患者于术后4周时再行清创,伤口正常愈合。所有患者病灶处未再次出现皮肤红肿及破溃,X线片显示植入的硫酸钙4周左右开始逐步吸收,8周左右有新骨生成,6~24个月病灶区骨缺损完全愈合。结论:负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎,临床疗效良好、可靠,值得临床推广。     

中西医结合治疗创伤性骨髓炎合并骨缺损

目的 研究应用中西医结合方法治疗创伤性骨髓炎合并骨缺损的疗效。方法 对１３２例创伤性骨髓炎合并骨缺损的患者根据创面细菌培养和药敏试验结果,分别选用有效中药于自控中药湿热熬治疗机上恒温冲洗创面２～４周,配合敏感抗菌素的应用,行病灶彻底清除和复合组织移植Ⅰ期治疗。结果 １３２例中２例手术失败,１２６例获得１～６年随访,１２１例治愈,２例骨髓炎复发,３例骨不愈合,结论 在中西医结合控制感染基础上,应用显     

妥布霉素在泌尿外科的初步应用

报告将妥布霉素应用于泌尿外科的初步结果,对慢性前列腺炎和女性下尿路感染的总有效率为77.27％,且其副作用较氨基糖甙类为轻。表明该药在防治泌尿外科疾病有较好的应用前景。     

吻合血管腓骨移植治疗胫骨慢性骨髓炎骨缺损

目的：报道吻合血管腓骨移植治疗胫骨慢性骨髓炎骨缺损的特点和优势。方法：应用带血管健侧腓骨之腓动静脉段血管与患侧胫有动静脉吻合血管腓骨于胫骨缺损处。结果：临床应用16例，术后6-10周出现临床愈合，1年后骨质愈合可负重。结论：吻合血管腓骨移植是治疗胫骨慢性骨髓炎骨缺损的有效方法，具有抗感染能力强，骨愈合快，植骨愈合后强度大，可早期负重的优点。     

慢性骨髓炎治疗的进展

慢性骨髓炎在临床上较为常见 ,病程长且难以治愈。传统上的慢性骨髓炎所致大段死骨形成并病理骨折 ,均主张采用保守治疗 ,待新生骨桥形成后 ,才做一次或多次死骨摘除术 ,该方式其病程需数月至数年之久。在这漫长的病程中 ,炎症反复发作 ,体质长期被消耗 ,给患者精神上、经济上带来难以承受的负担。在治疗上 ,国内尚征书[1] 曾用3 2 Ｐ对骨髓炎进行治疗 ,但其机理不详。而绝大多数慢性骨髓炎病例均需行手术。1　慢性炎症的控制1 1　控制慢性炎症的给药主要途径　在慢性骨髓炎的外科治疗中 ,有关抗生素的应用[2 ,3 ] ,多是根据所用药物应根据…     

载药硫酸钙富血小板血浆治疗股骨慢性骨髓炎

[目的]介绍载药硫酸钙富血小板血浆治疗Cierny-Mader III型股骨中下段慢性骨髓炎的手术技巧和初步临床效果。[方法] 2017年1月—2020年6月,对15例Cierny-MaderⅢ型股骨中下段慢性骨髓炎的患者,一期予高速钻头沿感染皮质骨边缘散在钻孔,摆锯、薄骨刀进行局部开窗,予咬骨钳清除硬化骨质、脓腔、炎性肉芽肿,予生理盐水、安尔碘反复冲洗。予钻头打通感染骨段远近端闭锁髓腔,放置负压封闭引流。二期沿原切口暴露骨缺损区,制备载药硫酸钙颗粒,将颗粒状硫酸钙与PRP混合,填塞股骨感染骨段髓腔,放置引流。[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症。所有患者均获随访,随访时间平均（26.1±6.3）个月,末次随访时,患肢疼痛VAS评分和HSS膝关节评分均显著改善（P<0.05）。影像检查见感染部位成骨良好。[结论]在开窗扩髓引流的基础上,载药硫酸钙富血小板血浆可有效治疗Cierny-MaderⅢ型股骨中下段慢性骨髓炎。     

妥布霉素雾化吸入治疗肺部感染效果观察

目的探讨治疗肺部感染的有效方法。方法将150例肺部感染患者随机分为观察组与对照组各75例。对照组采用传统的雾化液（庆大霉素、地塞米松、α-糜蛋白酶、生理盐水）雾化吸入，观察组采用妥布霉素注射液、地塞米松、α-糜蛋白酶、蒸馏水雾化吸入。均治疗7d比较治疗效果。结果观察组在痰量减少、呼吸音改善、哆音改善方面明显优于对照组（P＜0．05，P＜0．01）。结论妥布霉素抗菌谱广，雾化吸入治疗各种原因引起的肺部感染效果明显，且可避免使用庆大霉素引起的神经及耳毒性。     

采用带血管腓骨移植一期修复慢性骨髓炎大段骨缺损

目的 探索慢性骨髓炎大段骨早期摘除后骨缺损的一期修复效果。方法 胫骨慢性骨髓炎并大段骨清除后,作吻合血管腓骨移植一期予以重建１８例;作炎性骨段切除,采肜带血管蒂腓骨移位一期予以修复２例。结果 胫骨慢性骨髓炎在摘除在大段死骨后应用吻合血管腓骨移植或带血管腓骨移植或带血管蒂腓骨移位重建。术后３￣６个月见重建骨完全骨性愈合,邻近关节诸骨受累的炎症得到完全控制;修复肢体的功能与外形恢复令人满意。结论 对慢     

腓肠神经营养血管远端蒂皮瓣结合抗生素硫酸钙治疗跟骨慢性骨髓炎

背景:跟骨慢性骨髓炎是跟骨骨折术后发生的较为严重的并发症之一,其发生率日益增加,且处理较为棘手.目的:探讨应用腓肠神经营养血管远端蒂皮瓣及抗生素硫酸钙治疗跟骨慢性骨髓炎的方法和疗效.方法:回顾性研究2016年1月至2019年10月治疗的19例跟骨骨折所致跟骨慢性骨髓炎患者,男11例,女8例;年龄35～65岁,平均(45...     

应用Ilizarov技术修复胫骨慢性骨髓炎并骨缺损

目的探讨应用Ilizarov技术治疗胫骨创伤后慢性骨髓炎并感染性骨缺损的临床疗效。方法对8例胫骨创伤后慢性骨髓炎并感染性骨缺损行清创、可延长外固定架固定、干骺端截骨及中间骨段逐步搬运。结果 8例均获随访6～40个月,平均31.5个月。骨与皮肤缺损得到修复,患侧肢体长度与健侧无明显短缩。结论应用Ilizarov技术治疗难治性胫骨骨髓炎合并骨缺损或皮肤软组织缺损创伤小,能够避免多次复杂手术,可简化治疗过程,疗效肯定。     

载抗生素的硼酸盐生物玻璃治疗慢性骨髓炎的实验研究

目的硼酸盐生物玻璃具有良好的生物活性及生物相容性,在体内可以完全降解。通过将硼酸盐生物玻璃载万古霉素后植入清创后的兔胫骨骨髓炎病灶,探讨硼酸盐生物玻璃作为抗生素缓释载体的可行性。方法将万古霉素溶于固化液,再分别与硫酸钙粉末、硼酸盐生物玻璃粉末混合,制备抗生素缓释系统,万古霉素含量均为80 mg/g。健康成年雄性新西兰大白兔65只,体重2.12～3.91 kg,平均2.65 kg;于右膝骨髓腔注入0.1 mL浓度为1×109 cfu/mL的耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)悬液,制备骨髓炎模型。注射后3周,将54只模型制备成功的大白兔随机分成4组:A组(n=11)进行单纯清创处理;B组(n=11)、C组(n=16)、D组(n=16)彻底清创后,分别于缺损处植入硼酸盐生物玻璃、载万古霉素的硫酸钙、载万古霉素的硼酸盐生物玻璃。清创术中取坏死组织行细菌学检查。术后1、2、4、10、24、48 h时测量C、D组血清万古霉素浓度,10、24、48、72、120 h测量B、D组血清硼浓度;8周时处死全部实验动物摄X线片观察并评分;取胫骨进行细菌学检查及组织学观察。结果术后共10只实验动物死亡。C组术后各时间点均未检测到血清万古霉素;D组血清万古霉素浓度逐渐上升,术后4 h时达峰值,之后浓度迅速下降。B组术后各时间点均未检测到血清硼;D组术后10 h血清硼浓度即达峰值,之后呈逐渐下降趋势。X线片观察显示术后8周C组载万古霉素的硫酸钙均降解;D组载万古霉素的硼酸盐生物玻璃部分降解,但骨修复优于C组;B组硼酸盐玻璃无明显降解。术前各组X线片评分比较,差异均无统计学意义(P>0.05);术后8周D组评分与A、B、C组比较,差异均有统计学意义(P<0.05)。各组术中坏死组织细菌培养均提示为MRSA阳性。术后8周D组胫骨组织细菌培养阴性率81.25%,与A组36.36%及B组18.18%比较,差异有统计学意义(P<0.05);与C组73.33%比较差异无统计学意义(P>0.05)。组织学观察显示,D组载万古霉素的硼酸盐生物玻璃周围有大量新骨形成,未见任何异物反应。A、B、C、D组组织学评分分别为(6.45±3.62)、(7.55±3.36)、(4.27±2.91)、(3.81±3.04)分;D组与A、B组比较,C组与B组比较,差异均有统计学意义(P<0.05);其余各组间比较,差异均无统计学意义(P>0.05)。结论载万古霉素的硼酸盐生物玻璃在治愈兔慢性骨髓炎的同时可促进骨缺损修复。     

Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects

IntroductionThe purpose of this study was to observe the effects of induced membrane technique combined with two-stage internal fixation in the treatment of tibial osteomyelitis defects.MethodsA retrospective analyses for 67 cases of tibialosteomyelitis defects were admitted to our department between September 2012 to February 2015, which were treated with induced membrane technique. At the first stage, implanted with a PMMA cement spacer in the defects after radical debridement and fixed with reconstructive locked plate. Bone grafting and exchanged the plate with intramedullary nail at the second stage.ResultsIn current study, all patients were followed up for 18–35 months. Sixty-six patients achieved bone union with the average radiographic and clinical healing times of 5.55 ± 2.19 and 7.45 ± 1.69 months, respectively. Seven patients required a second debridement before grafting, while four patients experienced a recurrence of infection or a relapse following second stage treatment. Twelve patients experienced either knee or ankle dysfunctions and 2 patients faced delayed wound healing. Donor site complications includes pain and infection were found in 7 and 3 patients, respectively with delayed stress fracture in 1 patient only.ConclusionsInduced membrane technique for the treatment of tibial osteomyelitis defects, seems a reliable method. The use of reconstructive locked plate as a temporary internal fixation at the first stage and exchanged with intramedullary nail at the second stage, potentially achieves good clinical efficacy. Care should be taken to restore the joint function especially in distal tibia.     

Therapeutic decision in chronic osteomyelitis: sinus track culture versus intraoperative bone culture

Background  The ideal specimen for identification of the etiologic agents in chronic osteomyelitis for best antibiotic decision remains controversial. Objective  To assess the concordance of sinus track culture (STC) with that of intraoperative bone culture (IBC) to guide antibiotic therapy in chronic osteomyelitis. Methods  A prospective comparative study of chronic osteomyelitis patients seen in our centre from January 2004 to December 2006. Specimens from the depths of sinus track and intraoperative bone biopsy were obtained from each patient and subjected to microbiologic examination and their concordance determined. Results  In STCs Staphylococcus aureus has the highest sensitivity (60.5%), specificity (45.0%) and positive predictive value (72.2%). The overall sensitivity (50.9%), specificity (20%) and predictive value (47.5%) of sinus track specimens were very low. Antibiotic decision based on IBC showed 106 patients (82.8%) had resolution of chronic osteomyelitis at mean of 2 years follow-up. Conclusion  IBC appears to predict more reliably the complete etiologic organisms than STCs in chronic osteomyelitis.     

骨髓方治疗慢性骨髓炎的实验研究

目的　观察骨髓方治疗大鼠慢性骨髓炎的疗效。方法　采用SD大鼠建立慢性骨髓炎模型 ,随机分成四组 :骨髓方Ⅰ组、骨髓方Ⅱ组、对照组和空白组。治疗 1个月 ,观察WBC、RBC、E -C3bRR、E -ICR、血清溶菌酶含量、骨X线、病理组织学指标。结果　骨髓方Ⅰ、Ⅱ组与空白组差异有非常显著性 (P <0 0 1) ;RBC、E -C3bRR、E -ICR、血清溶菌酶含量指标骨髓方Ⅰ、Ⅱ组明显优于对照组(P <0 0 1)。光镜下病理组织学观察骨髓方Ⅰ、Ⅱ组明显优于对照组和空白组 ;电镜下 ,骨髓方Ⅰ、Ⅱ组细胞结构受损程度小于对照组和空白组。结论　骨髓方治疗慢性骨髓炎有较好疗效 ,提示与其提高机体免疫力、促进微循环和促进成骨有关     

Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis

Wide resection of infected bone improves the odds of achieving remission of infection in patients with chronic osteomyelitis. Aggressive debridement is followed by the creation of large bone defects. The use of antibiotic-impregnated PMMA spacers, as a customized dead space management tool, has grown in popularity. In addition to certain biological advantages, the spacer offers a therapeutic benefit by serving as a vehicle for delivery of local adjuvant antibiotics. In this study, we investigate the efficacy of physician-directed antibiotic-impregnated PMMA spacers in achieving remission of chronic tibial osteomyelitis. This retrospective case series involves eight patients with chronic osteomyelitis of the tibial diaphysis managed with bone transport through an induced membrane using circular external fixation. All patients were treated according to a standardized treatment protocol. A review of the anatomical nature of the disease, the physiological status of the host and the outcome of treatment in terms of remission of infection, time to union and the complications that occurred was carried out. Seven patients, with a mean bone defect of 7 cm (range 5–8 cm), were included in the study. At a mean follow-up of 28 months (range 18–45 months), clinical eradication of osteomyelitis was achieved in all patients without the need for further reoperation. The mean total external fixation time was 77 weeks (range 52–104 weeks), which equated to a mean external fixation index of 81 days/cm (range 45–107). Failure of the skeletal reconstruction occurred in one patient who was not prepared to continue with further reconstructive surgery and requested amputation. Four major and four minor complications occurred. The temporary insertion of antibiotic-impregnated PMMA appears to be a useful dead space management technique in the treatment of post-infective tibial bone defects. Although the technique does not appear to offer an advantage in terms of the external fixation index, it may serve as a useful adjunct in order to achieve resolution of infection.     

颅骨慢性骨髓炎的手术治疗

目的总结颅骨慢性骨髓炎的治疗方法及其疗效。方法 2004年1月-2009年2月,收治24例颅骨慢性骨髓炎患者。男16例,女8例;年龄18～56岁,平均45.6岁。病程3～11年,平均5.8年。病因:开颅术后感染3例,烧伤15例,电击伤6例。部位:额顶部10例,颞顶部8例,枕部6例。彻底清除感染坏死组织后软组织缺损范围为7 cm×6 cm～19 cm×12 cm,颅骨缺损范围为5 cm×4 cm～10 cm×7 cm。采用邻位头皮瓣(12例)、斜方肌肌皮瓣(6例)、游离股前外侧皮瓣(6例)修复,皮瓣切取范围为8 cm×7 cm～20 cm×13 cm。供区直接缝合或中厚皮片游离移植修复。结果术中病理检查均为颅骨化脓性骨髓炎伴死骨形成,1例发现局部鳞癌。术后2周1例出现皮瓣下感染,再次手术清除残留组织后愈合;其余皮瓣及皮片均成活好,切口Ⅰ期愈合。术后患者均获随访,随访时间10个月～4年,平均2年。皮瓣颜色、质地较好,骨髓炎无复发。1例局部鳞癌患者术后随访4年未复发。8例术后3～6个月出现头痛、头晕等颅骨缺损相关症状,二期行钛网颅骨重建。结论颅骨慢性骨髓炎应早期彻底清除感染病灶,选择适宜的皮瓣或肌皮瓣修复创面,可获满意效果。     

持续抗生素灌洗和载药人工骨植骨联合皮瓣或肌皮瓣移植治疗难治性慢性骨髓炎

慢性骨髓炎在临床上较为常见,病程长且难以治愈,给患者精神上、经济上带来难以承受的负担,如何在彻底控制感染的基础上达到临床治愈,一直是骨科医生探索的方向。随着医学及相关技术的发展,其治疗有了很大提高。2001年8月至2006年6月，共收治严重创伤术后伴有软组织缺损的难治性慢性骨髓炎13例，取得较满意疗效，现报告如下。     

慢性骨髓炎患者骨组织的转录组特征分析

目的：采集和分析慢性骨髓炎患者骨组织的转录组信息,为探究慢性骨髓炎发病的分子机制,明确MAPK信号通路在慢性骨髓炎发病过程中的作用。方法：收集2019年6月至2020年6月就诊的四肢创伤性骨髓炎4例,病灶骨样本(Necrosis组)以及正常骨组织(Control组),使用Illumina HiSeq Xten高通量测序平台采集转录组信息,并采用FPKM方法计算基因在骨组织中的表达量。通过对比病灶组织与正常组织的转录本水平,筛选差异基因,并进行GO富集和KEGG富集。采用大鼠骨髓炎动物模型,选取细胞外信号调节酶MAP3K7(mitogen-activated protein 3 kinase 7)、活化T细胞核因子1(nuclear factor of activated T cells 1,NFATC1)做差异靶点的免疫组化学的验证。结果：高通量测序共获得5 548个差异基因,其中Necrosis组上调 2 701个,下调2 847个。筛选正常骨组织和病灶骨的差异基因中富集到MAPK信号通路的基因,并与破骨细胞分化(osteoclast differentiation)信号通路相关的基因取交集,共有基因为核因子κB激酶亚基β抑制剂IκBKβ(inhibitor of nuclear factor kappa B kinase subunit beta)、MAP3K7、NFATC1、核因子κB亚基2(nuclear factor kappa B subunit 2,NFκB2)。在大鼠骨髓炎模型中,MAP3K7、NFATC1在骨髓以及损伤骨组织周围高表达。结论：基于转录组学分析显示慢性骨髓炎的发病和MAPK信号通路相关,IκBKβ、MAP3K7、NFATC1、NFκB2有可能成为新的临床诊断和疾病治疗的靶点。     

Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation-suction in the treatment of lower limb chronic osteomyelitis

Aims

We sought to compare the efficacy of antibiotic-loaded calcium sulphate with wound irrigation-suction in patients with lower limb chronic osteomyelitis.