万古霉素人工骨治疗老年慢性骨髓炎临床疗效及对患者血清肿瘤坏死因子水平的影响

摘要

目的 评价万古霉素人工骨治疗老年慢性骨髓炎临床疗效及对血清肿瘤坏死因子水平的影响.方法 回顾性分析,将永康市骨科医院收治的48例老年慢性骨髓炎患者作为研究对象,并随机分为对照组与试验组,每组24例.手术前3天对照组采用注射用氯唑西林钠2g/d,分4次静滴,试验组注射用盐酸去甲万古霉素0.8g/d,分2次静滴.术中对照组选取骨移植替代物5~10g,试验组联合注射用盐酸去甲万古霉素1g加水调制成糊状.术后对照组采用注射用氯唑西林钠2g/d,分4次静滴,试验组注射用盐酸去甲万古霉素0.8g/d,分2次静滴,连用2周.比较2组临床疗效、治疗前后血清C-反应蛋白(CRP)、红细胞沉降率(ESR)、血清肿瘤坏死因子(TNF-α)、核因子-κB(NF-κB)以及不良反应发生情况.结果 治疗后,试验组组临床总有效率为95.45%,显著高于对照组的 81.82% (P<0.05).2组治疗后血清CRP、ESR、TNF-α、NF-κB水平均显著降低,且试验组显著小于对照组(P<0.05).对照组不良反应发生率为16.67%,试验组为12.50%,差异无统计学意义.结论 万古霉素人工骨治疗老年慢性骨髓炎的临床疗效显著,显著降低血清肿瘤坏死因子水平,安全性高.%Objective To evaluate the the effect of vancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis and the influence to TNF-α.MethodsIn Yongkang orthopaedic hospital, 48 cases of elderly patients with chronic osteomyelitis were selected as the object of study, and were randomly divided into the control group and the experimental group, 24 cases in each group.This is a retrospective study.Three days before operation, the control group were given cloxacillin 2g/d by 4 times intravenous drip.The experimental group were given Norvancomycin Hydrochloride 0.8g/d by two times intravenous drip.In the process of operation, the control group were given bone graft substitutes 5-10g and the experimental group were given Norvancomycin Hydrochloride 1g that is added to the water to form a paste.After operation, the control group were given cloxacillin 2g/d by 4 times intravenous dripand the experimental group were given Norvancomycin Hydrochloride 0.8g/d by 2 times intravenous drip.The two groups were treated continuously for two weeks.The effect,CRP, ESR, TNF-α, NF-κB and adverse drug reactions were compared between the two groups.ResultsThe effect in the experiment group was 95.45%,is significant higher than that in the control group 81.82%(P<0.05).The serum level of CRP、ESR、TNF-α and NF-κB decreased post-treatment in the experiment group much lower than that in the control group (P<0.05).The adverse drug reactions was not statistically different between the two groups.ConclusionVancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis was effective with high safety and it can decrease the level of TNF-α.