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。

Clinical study on negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteomyelitis

Objective: To study the clinical effects of negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteomyelitis.Methods: From June 2013 to December 2016,there were 35 cases of chronic osteomyelitis patients in our department,including 23 males and 12 females,ranging in age from 11 to 65 years old,with an average of 34 years old. The course of disease ranged from 8 to 46 months,with an average of 26 months. All patients were chronic osteomyelitis caused by open wounds. The lesions had recurrent redness and swelling and purulent skin perforation. Thirty-two patients had positive results in bacterial culture of sinus secretions,and 3 patients had negative results. Imaging examination showed the lesions of bone destruction,bone defects,surrounded by bone hyperplasia sclerosis. At the first stage,complete debridement was performed to remove necrotic tissues and inflammatory tissues;and the dressing of negative pressure closed drainage was used to completely cover the wound so as to promote the repair of the wound. At the second stage,the vancomycin loaded,calcium sulfate and autogenous iliac cancellous bone were mixed into the bone graft complex to evenly fill the lesions. The healing of the wound was observed and X-ray examination of the lesion was carried out to observe the absorption of calcium sulfate and the growth of new bone.Results: Twenty-six patients underwent debridement and negative pressure closed drainage on time,6 patients 2 times,and 3 patients 3 times. Thirty-two patients had incisions healed with grade A;2 patients had incisions healed with grade B,and got completely healing after anti-infection,and wound dressing treatment;1 patient had an incision healed with grade C,and got normal healing after re-debridement at the 4th week after operation. All patients did not have skin redness and ulceration again. X-ray imaging showed that the implanted calcium sulphate was absorbed gradually around 4 weeks,new bone was formed at 8 weeks,and bone defects in the lesions area were healed completely at 6 months to 2 years.Conclusion: Negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteomyelitis is a good and reliable method,worthy of clinical promotion.