| 载抗生素硫酸钙结合自体骨Ⅰ期植骨治疗慢性跟骨骨髓炎 |
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Received:December 26, 2013
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| 作者 | Author | 单位 | Unit | E-Mail |
| 颜瑞健 |
YAN Rui-jian |
浙江省立同德医院骨科, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
jiayuan_402@163.com |
| 张春 |
ZHANG Chun |
浙江省立同德医院骨科, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 郭峭峰 |
GUO Qiao-feng |
浙江省立同德医院骨科, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 陆建伟 |
LU Jian-wei |
浙江省立同德医院骨科, 浙江 杭州 310012 |
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China |
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| 期刊信息：《中国骨伤》2014年27卷，第10期，第854-857页 |
| DOI：10.3969/j.issn.1003-0034.2014.10.013 |
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目的：探讨清创后伴有骨缺损的慢性跟骨骨髓炎的治疗方法及其疗效。
方法：自2009年6月至2011年6月，采用载抗生素硫酸钙结合自体骨Ⅰ期植骨的方法治疗52例慢性跟骨骨髓炎患者，其中男40例，女12例；年龄18～67岁，平均43岁；右侧32例，左侧20例；病程6个月～3年。皮肤软组织缺损面积3.0 cm×1.5 cm～23.0 cm×12.0 cm.按照Cierny-Mader分类法：Ⅲ型34例，Ⅳ型18例。观察治疗后感染控制情况、人工骨吸收及骨缺损修复愈合情况，并采用Maryland评分标准对足跟功能恢复程度进行评价。
结果：52例患者均获得随访，时间2～3.8年，平均2.8年。所有患者Ⅰ期治愈，其中2例患者分别于术后3、5个月复发，经再次手术治愈。骨缺损修复愈合时间为1.5～3.5个月，平均2.5个月。人工骨在影像学上完全吸收时间为1.2～3个月，平均2.2个月，10例拔管后存在局部渗出窦道，2～3个月愈合，与人工骨完全吸收时间一致。4例患者皮瓣、肌皮瓣修复术后皮瓣出现部分坏死，经治疗后创面均获得闭合修复。术后Maryland评分为88.15±7.70，优32例，良14例，可6例。
结论：应用载抗生素硫酸钙结合自体骨Ⅰ期植骨治疗慢性跟骨骨髓炎可获得满意的临床结果，长期结果需要进一步随访，同时人工骨渗出及其影响因素也需进一步研究。 |
| [关键词]:跟骨 感染 骨髓炎 骨移植 |
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| One-stage compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone for the treatment of chronic calcaneal osteomyelitis |
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Abstract:
Objective: To explore the treatment of chronic calcaneal osteomyelitis with bone defect after debridement and evaluate its clinical outcomes.
Methods: From June 2009 to June 2011,52 patients with chronic calcaneal osteomyelitis were treated with stage-one compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone,including 12 females and 40 males with an average age of 43 years old ranging from 18 to 67. According to Cierny-Mader classification,there were 34 cases with stage Ⅲ and 18 with stage Ⅳ. There were 32 cases on right side and 20 on left,with a course of 6 months to 3 years. The area of soft tissue wound ranged from 3.0 cm×1.5 cm to 23.0 cm×12.0 cm. The clinical effects were evaluated according to infection controlling,calcium sulfate absorption,bone defect repair and heel functional recovery.
Results: All patients were followed up for 2 to 3.8 years(averaged 2.8 years). Primary healing was achieved in 52 patients. Two cases of recurrence were found post-operatively,1 case in 3 months and another in 5 months,which were cured after a second operation. Bone repair healing was gained in 1.5 to 3.5 months (averaged 2.5 months). Complete radiological absorption of calcium sulfate was found in 1.2 to 3 months(averaged 2.2 months). Local exudation after removal of drainage tube had been persisting in 10 patients for 2 to 3 months,which was consistent with the time when cacium sulfate were totally absorbed. Flap had partial necrosis in 4 cases,and the wounds were closed after appropriate treatment finally. The mean Maryland score was 88.15±7.70. There were excellent results in 32 cases,good in 14,fair in 6.
Conclusion: A satisfactory short-term clinical results can be gained by one-stage compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone in chronic calcaneal osteomyelitis,but the long-term results need further follow-up. And much more study is also demanded to reduce the exudation of calcium sulfate. |
| KEYWORDS:Calcaneus Infection Osteomyelitis Bone transplantation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 颜瑞健,张春,郭峭峰,陆建伟.载抗生素硫酸钙结合自体骨Ⅰ期植骨治疗慢性跟骨骨髓炎[J].中国骨伤,2014,27(10):854~857 |
| 英文格式: | YAN Rui-jian,ZHANG Chun,GUO Qiao-feng,LU Jian-wei.One-stage compound grafting of antibiotic-impregnated calcium sulfate and autogenous cancellous bone for the treatment of chronic calcaneal osteomyelitis[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(10):854~857 |
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