糖尿病并发慢性骨髓炎的临床治疗方法探讨

摘要

目的；通过对39例糖尿病合并慢性骨髓炎治疗的回顾性分析,探讨糖尿病并发慢性骨髓炎的治疗方法.方法；分析2000年至2011年收治的39例糖尿病并发慢性骨髓炎患者,其中男23例,女16例,年龄21～81岁,平均45岁,患者均有不同程度的红肿热痛表现,病程均在3个月以上.其中,25例术前有窦道形成.术前均常规行引流液培养、X线及CT检查.27例行清创Ⅰ期植骨外固定术,12例行清创术,术后均联合抗生素治疗.通过比较治疗前后血沉、C-反应蛋白和血常规测量结果、术前术后穿刺结果及影像学检查综合评定治疗效果.结果:治疗前35例出现血沉增快,治疗后32例转阴；治疗前25例血常规异常,治疗后23例转阴；术前36例C-反应蛋白升高,治疗后33例转阴.治疗后病灶脓液培养均为阴性.39例中,临床治愈33例,4个月至4年内复发6例.结论:在常规慢性骨髓炎治疗的同时,应重视并积极治疗糖尿病,采用综合治疗方法能明显提高糖尿病并发慢性骨髓炎的治愈率.%Objective: To investigate treatment methods for diabetes complicated with chronic osteomyelitis. Methods: The clinical data of 39 diabetic patients with chronic osteomyelitis from 2000 to 2011 were studied. Among the patients,23 patients were male and 16 patients were female,ranging in age from 21 to 81 years old,with a mean of 45 years old. All the patients had symptoms such as red,swelling,hot and pain to different degrees,and the duration of the disease lasted over more than 3 months,among which,25 patients had preoperative sinus formation. Routine preoperative drainage fluid culture,X-ray and CT examination were performed. Twenty-seven patients underwent debndement,one stage bone grafting and external fixation; 12 patients underwent debridement and antibiotic treatment. The examination results of ESR.CRP and blood routine before and after treatment were compared to evaluate clinical effects. Results: After treatment, the values of ESR (preoperative 35 patients with higher value,and postoperative 32 patients with normal value),blood routine (preoperative 25 patients with abnormal value,and postoperative 23 patients with normal value) ,and CRP(preoperative 36 patients with higher value,and postoperative 33 patients with normal value) all improved. The liquor puris cultures were negative after treatment. Among 39 patients, 33 patients had clinical cure;6 patients recurred within 4 months to 4 years. Conclusion;The treatment of diabetes should be paid attention when the chronic osteomyelitis was treated,and the combination treatment can significantly improve the cure rate of diabetes complicated with chronic osteomyelitis.