| 载万古霉素骨水泥治疗Wagner Ⅱ-Ⅳ级糖尿病足病例对照研究 |
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投稿时间：2021-07-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 吕和 |
LYU He |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
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| 祝海炳 |
ZHU Hai-bing |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
554255081@qq.com |
| 马一平 |
MA Yi-ping |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
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| 张永涛 |
ZHANG Yong-tao |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
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| 胡成挺 |
HU Cheng-ting |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
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| 应昀峰 |
YING Yun-feng |
舟山市中医院足踝儿科, 浙江 舟山 316000 |
Paediatrics of Foot and Ankle, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第10期，第947-952页 |
| DOI：10.12200/j.issn.1003-0034.2021.10.012 |
| 基金项目: |
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中文摘要:
目的：探讨载万古霉素骨水泥治疗WagnerⅡ-Ⅳ级糖尿病足（diabetic foot ulcer，DFU）溃破创面临床效果。
方法：自2019年3月至2021年4月按治疗方法不同将32例WagnerⅡ-Ⅳ级糖尿病足患者分为负压封闭引流（vacuum sealing drainage，VSD）组和骨水泥组。VSD组16例，男8例，女8例；年龄66~81（70.50±7.20）岁，病程8~40（27.56±8.55）个月；Wagner分级Ⅱ级2例，Ⅲ级7例，Ⅳ级7例；采用清创和VSD治疗。骨水泥组16例，男9例，女7例；年龄63~79（69.56±7.29）岁，病程11~39（22.75±11.43）个月；Wagner分级Ⅱ级2例，Ⅲ级5例，Ⅳ级9例；采用载万古霉素骨水泥治疗。观察并比较两组患者术中细菌培养的细菌种类、细菌培养转阴时间、皮肤愈合时间、住院时间、手术次数和并发症情况。
结果：所有患者获得随访，时间3~6（4.00±1.07）个月。骨水泥组细菌转阴时间、皮肤愈合时间、住院时间均明显低于VSD组（P<0.05）。两组手术次数中位数均为2次，差异无统计学意义（P>0.05）。根据两组病原菌分析提示：革兰氏阳性菌（Gram-positive bacteria，G+）患者13例，革兰氏阴性菌（Gram-positive bacteria，G-）患者14例，混合菌患者共5例。骨水泥组G+、G-、混合菌例数分别为6、7、3例，VSD组G+、G-、混合菌例数分别为7、7、2例。两组共32例患者创面均完全愈合，无并发症发生。
结论：载万古霉素骨水泥在治疗WagnerⅡ-Ⅳ级糖尿病足溃破创面效果明显，能够减少其住院时间、缩短皮肤愈合时间、尽快杀灭病原菌，是治疗WagnerⅡ-Ⅳ级糖尿病足创面溃破的有效方法之一。 |
| 【关键词】万古霉素 抗生素骨水泥 糖尿病足 |
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| A comparative study of vancomycin loaded bone cement in the treatment of Wagner Ⅱ-Ⅳ diabetic foot |
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ABSTRACT
Objective: To investigate the clinical effect of vancomycin bone cement in the treatment of diabetic foot ulcer (DFU) ruptured Wagner gradeⅡ-Ⅳ.
Methods: From March 2019 to April 2021,32 patients with Wagner gradeⅡ-Ⅳ diabetic foot were divided into vacuum sealing drainage(VSD) group and bone cement group according to different treatment methods. There were 16 cases in VSD group,8 males and 8 females;the age ranged from 66 to 81 (70.50±7.20) years,and the course of disease ranged from 8 to 40 (27.56±8.55) months;Wagner gradeⅡ in 2 cases,grade Ⅲ in 7 cases and grade Ⅳ in 7 cases;debridement and VSD were used. There were 16 cases in the bone cement group,9 males and 7 females;the age ranged from 63 to 79 (69.56±7.29) years,and the course of disease ranged from 11 to 39(22.75±11.43) months;Wagner gradeⅡ in 2 cases,grade Ⅲ in 5 cases and grade Ⅳ in 9 cases;vancomycin loaded bone cement was used for treatment. The types of bacteria,negative time of bacterial culture,skin healing time,hospital stay,operation times and complications were observed and compared between two groups.
Results: All patients were followed up for 3 to 6(4.00±1.07) months. The bacterial negative time,skin healing time and hospital stay in bone cement group were significantly lower than those in VSD group(P<0.05). The median number of operations in both groups was 2,and there was no significant difference(P>0.05). According to the analysis of pathogens in two groups,there were 13 cases of G+ patients,14 cases of G- patients and 5 cases of mixed bacteria. The number of G+,G- and mixed bacteria in bone cement group was 6,7 and 3 cases respectively,and the number of G+,G- and mixed bacteria in VSD group was 7,7 and 2 cases respectively. The wounds of 32 patients in two groups healed completely without complications.
Conclusion: Vancomycin loaded bone cement is effective in the treatment of Wagner grade Ⅱ-Ⅳ diabetic foot ulceration wounds. It can reduce the length of hospital stay,shorten the healing time of skin and kill pathogens as soon as possible. It is one of the effective methods to treat Wagner gradeⅡ-Ⅳ diabetic foot ulceration. |
| KEY WORDS Vancomycin Antibiotic bone cement Diabetic foot ulcer |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吕和,祝海炳,马一平,张永涛,胡成挺,应昀峰.载万古霉素骨水泥治疗Wagner Ⅱ-Ⅳ级糖尿病足病例对照研究[J].中国骨伤,2021,34(10):947~952 |
| 英文格式: | LYU He,ZHU Hai-bing,MA Yi-ping,ZHANG Yong-tao,HU Cheng-ting,YING Yun-feng.A comparative study of vancomycin loaded bone cement in the treatment of Wagner Ⅱ-Ⅳ diabetic foot[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(10):947~952 |
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