负载妥布霉素的硫酸钙治疗慢性骨髓炎及合并骨缺损的疗效评价

目的评价应用负载妥布霉素的硫酸钙（Osteoset-T）治疗慢性骨髓炎及合并骨缺损的疗效.方法自2004年4月起,采用Wright公司的Osteoset-T治疗慢性骨髓炎患者4例,慢性骨髓炎合并骨缺损患者11例.其中同时应用带蒂腓肠神经营养皮瓣转移治疗慢性窦道切除后皮肤缺损4例,带蒂小腿内侧皮瓣转移修复1例,平行桥式血管吻合游离背阔肌皮瓣移植1例.所有骨髓炎病例经过彻底清创,去除死骨与肉芽组织后植入Osteoset-T 5～25 mL,平均8.3 mL.结果所有患者平均随访4.5个月.15例患者中13例感染得到控制;2例混合感染者术后渗出较多,经过再次清创取出分解的Osteoset-T后创面愈合.11例骨髓炎合并骨缺损患者中5例术后4周开始出现不同程度的新骨形成,其中3例跟骨骨髓炎患者术后2个月部分负重行走,3个月恢复行走;1例股骨骨髓炎合并骨不连患者术后2个月新骨形成;1例桡骨骨髓炎患者术后6个月骨完全愈合.6例炎症得到控制但无新骨形成,均行自体骨或异体骨植骨后2例已经完全愈合,4例在愈合过程中.结论应用彻底清创合并Osteoset-T可以有效地治疗慢性骨髓炎,并可在一定程度上促进新骨的形成.

Efficacy evaluation of Osteoset-T in treatment of chronic osteomyelitis with or without bone defects

Objective To evaluate the effects of Osteoset-T (calcium load tobramycin) in treatment of chronic osteomyelitis with or without bone defects. Methods From April 2004, we treated 11 cases of osteomyelitis with bone defects and 4 without bone defects by using Osteoset-T. Skin defects after removal of chronic sinus were covered with different kinds of flaps in 6 cases, including pedicel sural nerve flap in 4 cases, posterior tibial flap in 1 case, and parallel bridge vessel anastomosis free dorsi latissimus myocutaneous flap transplantation in 1 case. After thorough debridement to wipe out dead bone and granulation tissue, Osteoset-T of 5-25 mL was put into the space, with an average volume of 8.3 mL. Results All the 15 patient were followed up for 3 to 8 months with an average of 4.5 months. Infection was controlled in 13 cases. In 2 cases who experienced mixed infection and excessive effusion, wounds healed after second debridement and removal of partially decomposed Osteoset-T. New bone could be found in 5 cases after 4 weeks, of whom 3 cases of calcaneus osteomyelitis resumed partial weigh bearing walking after 1 month and normal walking in 3 months postoperatively. 2 months after operation, new bone formed in 1 case of femoral osteomyelitis and nonunion. Bone healed 6 months after operation in 1 case of radial osteomyelitis. Infection could be controlled but no new bone was formed in 6 cases, for whom autogenous or heterogenous bone grafts were performed afterwards. Of them, 2 cases healed and 4 cases were in the healing process. Conclusion It is practical to control chronic osteomyelitis effectively by using thorough debridement and Osteoset-T implantation, and hence to induce new bone formation to some degree.