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.

One-stage compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone for the treatment of chronic calcaneal osteomyelitis

Objective：To explore the treatment of chronic calcaneal osteomyelitis with bone defect after debridement and evaluate its clinical outcomes.Methods：From June 2009 to June 2011,52 patients with chronic calcaneal osteomyelitis were treated with stage-one compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone,including 12 females and 40 males with an average age of 43 years old ranging from 18 to 67.According to Cierny-Mader classification,there were 34 cases with stage Ⅲ and 18 with stage Ⅳ.There were 32 cases on right side and 20 on left,with a course of 6 months to 3 years.The area of soft tissue wound ranged from 3.0 cm×1.5 cm to 23.0 cm×12.0 cm.The clinical effects were evaluated according to infection controlling,calcium sulfate absorption,bone defect repair and heel functional recovery.Results：All patients were followed up for 2 to 3.8 years （averaged 2.8 years）.Primary healing was achieved in 52 patients.Two cases of recurrence were found post-operatively,1 case in 3 months and another in 5 months,which were cured after a second operation.Bone repair healing was gained in 1.5 to 3.5 months （averaged 2.5 months）.Complete radiological absorption of calcium sulfate was found in 1.2 to 3 months（averaged 2.2 months）.Local exudation after removal of drainage tube had been persisting in 10 patients for 2 to 3 months,which was consistent with the time when cacium sulfate were totally absorbed.Flap had partial necrosis in 4 cases,and the wounds were closed after appropriate treatment finally.The mean Maryland score was 88.15±7.70.There were excellent results in 32 cases,good in 14,fair in 6.Conclusion：A satisfactory short-term clinical results can be gained by one-stage compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone in chronic calcaneal osteomyelitis,but the long-term results need further follow-up.And much more study is also demanded to reduce the exudation of calcium sulfate.