抗生素骨水泥链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎

摘要

目的 探讨应用抗生素骨水泥链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎的临床疗效.方法 回顾性分析我院2012年1月至2016年1月行手术治疗32例股骨及胫骨慢性骨髓炎病人,采用分期治疗:一期进行彻底清创、去除死骨、放置万古霉素骨水泥链珠,安装环形外固定延长架;二期取出万古霉素抗生素链珠,进行截骨延长、骨搬移.定期影像学检查观察骨搬移情况,骨搬移结束后视断端对合情况决定是否植骨.采用Paley评分和美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分对骨性愈合及下肢功能情况进行评估.结果 32例病人均获得随访,随访时间为16~64个月.病人治疗结束后炎症完全控制,且均达到骨性愈合,其中12例在搬移结束后行自体骨移植,20例断端对合后骨性愈合.所有病人均恢复了日常生活.Paley评分骨性结果:优21例,良11例.功能结果:优23例,良7例,一般2例.搬移结束后HSS评分为(92.19±7.24)分,与术前的(71.94±11.10)分比较,差异有统计学意义(t=14.240,P<0.001).结论 抗生素链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎临床疗效最终达到骨性愈合,是治疗慢性骨髓炎的有效方法.%Objective To investigate the clinical efficacy of antibiotic-PMMA beads combined with bone transport technique in the treatment of chronic osteomyelitis of the lower limb. Methods The surgical efficacy of 32 patients with chronic osteomyelitis was retrospectively analyzed in our hospital from January 2012 to January 2016. The methods of staging treatment were as follows:stageⅠ, a complete debridement, removal of sequestrum, placement of vancomycin-PMMA beads and the installation of ring external fixation; stage Ⅱ, removal of the vancomycin-PMMA beads, the osteotomy extension and bone transport technique. Regular X-ray examination was carried out to observe the situation of bone removal. According to the gap between the fracture sites, bone grafting was decided. The fracture healing, lower limb function, and knee joint function were evaluated using the Paley score and the Hospital for Special Surgery (HSS) knee score. Results All 32 patients were followed up for 16 to 64 months. After treatment the infection in all patients was healed and bone union was obtained. Autogenous bone grafting was performed on 12 patients. All patients were restored to daily life. For Paley score for bone union, excellent efficacy was achieved in 21 cases, and good in 11 cases. For Paley score for lower limb function results, excellent efficacy was achieved in 23 cases, good in 7 cases, and fair in 2 cases. The scores of HSS were 92.19 ± 7.24 after bone union and 79.94 ± 11.10 before operation with the difference being statistically significant (t=14.240, P<0.001). Conclusion It is an effective method to treat the lower limb chronic osteomyelitis by antibiotic-PMMA beads combined with bone transport technique.