创伤性骨髓炎感染控制的临床研究

目的探讨一期持续闭合灌洗、二期万古霉素硫酸钙植入(和)皮瓣移植治疗创伤性骨髓炎骨感染的临床疗效。方法对2013年7月—2016年12月无锡市第九人民医院收治的创伤性骨髓炎有完整资料的141例患者进行回顾分析,其中男性121例,女性20例,平均年龄43.7岁(27~73岁);病程4周~19个月,平均9.3个月。其中胫骨95例(合并腓骨9例),股骨19例,跟骨15例,肱骨6例,尺骨、桡骨及髂骨各2例。创面细菌培养阳性126例,其中革兰氏阳性球菌占57.1%(72例),革兰氏阴性杆菌占35.7%(45例),混合感染占7.2%(9例)。合并软组织缺损需行皮瓣移植61例(胫骨57,跟骨3例,尺骨1例)。结果随访时间3~19个月,平均8.7个月,持续闭合灌洗治疗时间2~4周,平均2.8周;其中5例术后由于引流不畅更换1次VSD。硫酸钙人工骨4周开始吸收,8周完全吸收。术后3周拆线时,甲类愈合107例(75.9%),乙类愈合34例(24.1%),甲类+乙类愈合100%。结论彻底清创、消灭死腔、持续有效的灌洗结合负载万古霉素的硫酸钙治疗创伤性骨髓炎骨感染,方法简单,效果良好,避免了全身给药带来的一系列不良反应,但其治疗时间较长。

Clinical study of infection control on traumatic osteomyelitis

Objective To investigate the effect for the treatment of traumatic osteomyelitis of bone infection by continuous closed irrigation first and then vancomycin calcium sulfate implantation .Methods From Jul.2013 to Dec.2016,141 traumatic osteomyelitis patients were retrospectively analyzed.There were 121 males and 20 fe-males,with an average age of 43.7 years (from 27 to 73years),and the average course of 9.3 months(from 4 weeks to 19 months).There were 95 tibias (9 cases with fibula concurrence ),19 femurs,15 calcaneuses,6 humeruses,ul-na,radius and iliac bone in 2 cases, respectively.Bacterial culture was positive in 126 cases,of which gram positive cocci accounted for 57.1%(n＝72),gram negative bacilli accounted for 35.7%(n＝45),mixed infection accoun-ted for 7.1%(n＝9).And 61 cases (57 cases of tibia,3 cases of calcaneus and 1 case of ulna) had soft tissue de-fect in demand of skin flap transplantation.Results All cases were followed -up from 3 to 19 months(average, 8.7 months),the duration of continuous closed irrigation was 2-4 weeks(average 2.8 weeks),5 cases had VSD changed due to poor drainage.Calcium sulfate artificial bone was absorbed at 4 weeks,and was absorbed completely at 8 weeks.Three weeks after operation ,there were 107 cases (75.9%) healed in class Ⅰ,and 34 cases (24.1%) in class Ⅱ.Conclusion The way of thorough debridement ,eliminating dead space,sustained and effective load of vancomycin lavage combined with calcium sulfate is simple and has a good effect for the treatment of traumatic osteo -myelitis.It can avoid a series of adverse reactions caused by systemic delivery ,but the treatment time is long.