载药硫酸钙富血小板血浆治疗股骨慢性骨髓炎△

Antibiotic-loaded calcium sulfate combined with platelet-rich plasma for chronic osteomyelitis of the distal femur

摘要:

[目的] 介绍载药硫酸钙富血小板血浆治疗 Cierny-Mader III 型股骨中下段慢性骨髓炎的手术技巧和初步临床效果。 [方法]2017 年 1 月—2020 年 6 月，对 15 例 Cierny-Mader Ⅲ型股骨中下段慢性骨髓炎的患者，一期予高速钻头沿感染皮质骨边缘散在钻孔，摆锯、薄骨刀进行局部开窗, 予咬骨钳清除硬化骨质、脓腔、炎性肉芽肿，予生理盐水、安尔碘反复冲洗。予钻头打通感染骨段远近端闭锁髓腔，放置负压封闭引流。二期沿原切口暴露骨缺损区，制备载药硫酸钙颗粒，将颗粒状硫酸钙与 PRP 混合，填塞股骨感染骨段髓腔，放置引流。[结果]所有患者均顺利完成手术，术中无血管、神经损伤等严重并发症。所有患者均获随访，随访时间平均(26.1±6.3)个月，末次随访时，患肢疼痛 VAS 评分和 HSS 膝关节评分均显著改善(P＜0.05)。 影像检查见感染部位成骨良好。[结论]在开窗扩髓引流的基础上，载药硫酸钙富血小板血浆可有效治疗 Cierny-MaderⅢ型股骨中下段慢性骨髓炎。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of antibiotic-loaded calcium sulfate com- bined with platelet-rich plasma for treatment of chronic osteomyelitis of the distal femur. [Methods] From January 2017 to June 2020, 15 pa- tients received abovementioned therapy for Cierny-Mader type III chronic osteomyelitis in the distal femur. In the first-stage operation, the cortical bone margin over the infected lesion were drilled with a high-speed drill, fenestrated with a thin osteotome, debrided to remove all the sclerosing bone, abscess and inflammatory tissue, and rinsed with normal saline and Entoiodine repeatedly. The proximal and distal med- ullary cavities were opened by gradual drill bits, and negative-pressure closed drainage was placed. A week later, the second-stage opera- tion was conducted through the original incision. After debridement, sensitive antibiotics loaded calcium sulfate particles were prepared, then mixed with PRP to fill the medullary cavity with drainage placed. [Results] All patients had operations successfully completed with no vascular nerve injury and other serious complications. All patients were followed up for an average of (26.1±6.3) months. At the last followup the pain VAS score and HSS knee score of the affected limb were significantly improved (P＜0.05). The images showed good osteogenesis at the lesion site. [Conclusion] This antibiotic-loaded calcium sulfate combined with platelet-rich plasma does effectively treat chronic os- teomyelitis of the distal femur.