改良VSD髓内引流结合载抗生素硫酸钙植入治疗慢性骨髓炎的疗效分析

摘要

Objective To investigate the efficacy of the combination of improved intramedullary VSD drainage and contained antibiotics bone graft to treat chronic tubular bones osteomyelitis.Methods From March,2011 to December,2013,our department have total of 40 patients with chronic tubular bones osteomyelitis.Twenty cases (group A) treat with one-stage osteomyelitis debridement cortical bone slotted,contained antibiotic bone and autologous bone implants and wound repair.Twenty cases (group B) treat with improved intramedullary VSD drainage 3-5 days temporarily after osteomyelitis debridement cortical bone slotted,then contained antibiotic bone and autologous bone implants and wound repair.A retrospective comparison of two groups of an average residence time of wound drainage postoperative,bone bed bacterial culture positive rate,average healing time,the average time of hospital stay,the average bone healing time,and recurrence rate of osteomyelitis.Statistical analysis with T test was used for above independent parametric.Results The two groups were followed-up for 6-24 months,independent samples t-test was used for two groups in the wound healing time,bone healing time,the drainage tube removal time and the length of hospital stay,in group A bone bed bacteria culture positive rate was 40％,group B was 5％,group A infection relapse has 2 cases,1 case was debridement cured,1 case was amputation,and the recurrence rate of 10％.Group B without infection recurrence,and the recurrence rate of 0％ ; The healing time and hospital stay of intramedullary drainage surgery patients (18.05 ± 2.74 d and 22.65 ± 2.80 d,respectively,in group B) was significantly less than one-stage surgery patients (24.10 ± 8.20 d and 28.10 ± 9.35 d,respectively,in group A),but the bone healing time and the drainage tube removal tine of two groups.There was no significant difference (P ＞ 0.05).Conclusion Contained antibiotic bone and autologous bone implants with wound healing therapy after osteomyelitis debridement cortical bone slotted with improvement VSD intramedullary drainage to treat patient with tubular bones osteomyelitis was more effective,it worthy of clinical spread.%目的 探讨应用改良VSD髓内引流结合载抗生素硫酸钙植入治疗管状骨慢性骨髓炎的疗效分析. 方法 回顾性分析自2011年3月至2013年12月入住我科的管状骨慢性骨髓炎患者40例资料:一期行骨髓炎病灶清除骨皮质开槽、载抗生素硫酸钙与自体骨植入及创面修复20例(A组);行病灶清除骨皮质开槽术后暂予以改良VSD髓内引流术后3～5d后再予行载抗生素硫酸钙与自体骨植入及创面修复20例(B组).回顾性对比两组患者平均术后创口引流管滞留时间、植骨床细菌培养阳性率、平均创面愈合时间、平均住院时间、平均骨愈合时间和骨髓炎复发率.并对以上指标行独立样本t检验统计学分析. 结果 两组病例随访6～ 24个月,对两组病例在创面愈合时间、骨愈合时间、引流管拔除时间及住院时间上进行独立样本t检验,植骨床细菌培养阳性率A组40％,B组5％,A组复发2例,1例经过清创后治愈,1例截肢,复发率10％,B组无复发;B组的创面愈合时间及住院时间分别为(18.05±2.74)d和(22.65±2.80)d,显著少于A组[分别为(24.10±8.20)d和(28.10±9.35)d],但在骨愈合时间及引流管拔除时间上两组病例差异无统计学意义(P＞0.05). 结论 病灶清除骨皮质开槽加改良VSD髓内引流后再行载抗生素硫酸钙与自体骨植入加创面修复治疗管状骨骨髓炎更有效,值得临床推广.