病灶清除载抗生素硫酸钙置入治疗硬化性骨髓炎△

Debridement and antibiotic-loaded calcium sulfate for treatment of sclerosing osteomyelitis

摘要:

［目的］ 探讨病灶清除联合抗生素人工骨治疗硬化性骨髓炎的临床疗效。［方法］ 回顾性分析本科 2016 年 2 月— 2020 年 11 月收治的 28 例硬化性骨髓炎患者的临床资料，所有患者均行病灶清除抗生素人工骨植入术。观察临床及实验室检查结果。［结果］28 例患者均顺利完成手术，无严重并发症。术后 1 周患肢肿痛逐渐消失、伤口愈合。平均随访时间（30.18± 18.43）个月，末次随访时 VAS 评分较术前显著降低（P<0.05）。所有患者均未出现病理性骨折，2 例术后复发，再次病灶清除载抗生素硫酸钙置入后治愈。影像方面，末次随访时病灶愈合骨改建，人工骨已完全吸收。与术前相比，末次随访时 CRP、 ESR 和 WBC 均显著降低 （P<0.05）。［结论］ 病灶清除联合抗生素人工骨植入治疗硬化性骨髓炎可以有效控制感染、缓解疼痛，值得临床推广。

Abstract:

[Objective] To investigate the clinical efficacy of debridement combined with antibiotic-loaded calcium sulfate implanta- tion in the treatment of sclerosing osteomyelitis. [Methods] A retrospective study was conducted on 28 patients who received surgical de- bridement combined with antibiotic-loaded calcium sulfate implantation for sclerosing osteomyelitis in our department from February 2016 to November 2020. The clinical and laboratory results were observed. [Results] All 28 patients were successfully operated on without seri- ous complications. One week after surgery, the swelling and pain disappeared gradually with well incision healing in all the patients. The VAS score significantly decreased at the latest follow-up lasted for (30.18±18.43) months on an average compared with that preoperatively (P＜0.05) . None of the patients had pathological fracture, whereas 2 patients had local recurrence after surgery, which were cured after re- vised debridement and antibiotic-loaded calcium sulfate implantation. Radiographically, the lesion healed with bone remodeling and com- plete absorption of the implant at the last follow-up. The CRP, ESR and WBC significantly declined at the latest follow-up compared with those preoperatively (P＜0.05) . [Conclusion] Debridement combined with antibiotic-loaded calcium sulfate implantation does effectively control infection and relieve pain for sclerosing osteomyelitis.