Objective:To investigate the therapeutic effect of modified Papineau technique and calcium phosphate topical filling in the treatment of Ceimy type Ⅲ osteomyelitis after distraction osteogenesis.Methods:Retrospective study of 17 cases suffering from Ceimy type Ⅲ osteomyelitis during osteogenesis performance who were treated with vancomycin loaded calcium phosphate cement (Group A) and topical filling and cancellous autograft (Group B,modified Papineau technique) was performed from January 2013 to April 2015.There were 6 cases in Group A,in which 0.5 g vancomycin was mixed into 5 ml calcium phosphate cement and 11 cases in Group B,in which 0.5 g vancomycin was mixed into 5 mL autogenous cancellous graft.Both groups underwent 7 days vacuum assisted closure immediately after operation.The time of relieving of pain,swelling,exudates was recorded and healing of sinus and bone were followed.Results:All patients were followed for 12～20 months.In group A,Infection was relieved and wound healed in 2-3 weeks.WBC,CRP and ESR decreased gradually to normal.Two patients was cured without recurrence while the other 4 cases exudate again with increase of ESR and CRP in 3～10 weeks after operation.After dressing exchanged daily,the wounds healed gradually and no recurrence occurs again.In group B,all wounds healed in 2-3 weeks and WBC,CRP and ESR returned to normal.No recurrence was identified.Conclusions:Combining with vancomycin topical application,both calcium phosphate cement topical filling and modified Papineau technique are effective in the treatment of distraction osteogenesis with Ceimy Type Ⅲ osteomyelitis complicated,but the former has higher recurrence rate and the later is more reliable.%目的:探讨改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术使用中并发CeimyⅢ型骨髓炎的疗效.方法:回顾性分析自2013年1月到2015年4月采用改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术并发CeimyⅢ型骨髓炎17例.A组6例,采用清创后磷酸钙骨水泥5mL混合0.5 g万古霉素粉剂清创后填塞治疗.B组11例,采用改良Papineau植骨术,即清创后,按5mL体积松质骨混合0.5g万古霉素粉剂,清创后植入缺损部位.两组病例术后均行封闭负压吸引(VAC)治疗7天.随访病人局部疼痛缓解情况,皮肤红肿表现、窦道愈合情况、骨缺损部位骨愈合情况以及术后复发情况来判定疗效并比较分析.结果:17例病人术后随访12～20个月.A组全部病例术后2～3周局部炎症消退,创口愈合,定期检测血白细胞计数(WBC)、血沉(ESR)和C反应蛋白(CRP)均下降至正常,2例再未出现感染征象,4例病人于术后3～10周再次出现渗液,局部皮肤发红,ESR、CRP进行性升高表现.再次给与清创,换药治疗后逐渐愈合,随访再无渗液出现.B组病人11例,创口2～3周内全部愈合,定期检测WBC、ESR和CRP均下降至正常.随访未见复发.结论:抗生素负荷磷酸钙骨水泥在牵张成骨技术治疗后并发Ceimy Ⅲ型骨髓炎时,虽有效果,但复发率较高,改良Papineau植骨术疗效更好.
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