胫骨平台骨折内固定感染万古霉素硫酸钙植入

Imlpantation of vancomycin-calcium sulfate composite for osteomyelitis secondary to open reduction and internal fixation of tibial plateau fractures

摘要:

[目的] 探讨万古霉素硫酸钙植入治疗胫骨平台骨折切开复位内固定术后感染的临床疗效。[方法] 回顾性分析 2014 年 3 月—2022 年 4 月收治的 37 例胫骨平台骨折内固定术后感染患者的临床资料，所有患者均行病灶清除万古霉素硫酸钙植入。评价临床及检验结果。[结果]37 例患者均顺利完成手术，手术时间平均（113.1±39.5） min，术中出血量平均（156.8± 78.3）mL。随访时间平均（38.3±22.8）个月，2 例患者术后感染复发，经再次病灶清除植入万古霉素硫酸钙后感染控制。骨愈合时间平均 （7.9±2.9） 个月。与术前相比，患者出院及末次随访时 ROM [(39.4±7.3)°, (55.4±7.3)°, (106.1±17.3)°, P＜0.001]、KSS 临床评分 [(19.1±3.9), (30.0±2.7), (80.8±5.0), P＜0.001]、KSS 功能评分 [(19.9±14.7), (38.8±4.9), (85.7±5.1), P＜0.001]、HHS 评分 [(31.8±6.4), (40.0±5.4), (73.8±9.1), P＜0.001] 均显著增加。检验方面，与术前相比，患者出院及末次随访时，CRP、WBC、ESR 水平均显著降低，3 项指标均在平均 （5.4±2.5） 周恢复正常。[结论] 根据感染及骨折愈合情况，保留或拆除内固定，植入万古霉素硫酸钙并及时应用外固定架是治疗胫骨平台骨折内固定后感染的可靠方法，可有效控制感染，促进功能恢复。

Abstract:

[Objective] To investigate the clinical outcomes of implantation of vancomycin and calcium sulfate composite in the treatment of osteomyelitis secondary to open reduction and internal fixation (ORIF) of tibial plateau fracture. [Methods] A retrospective study was conducted on 37 patients who suffered from osteomyelitis after ORIF of tibial plateau fractures in our hospital from March 2014 to April 2022. All patients underwent debridement and implantation of vancomycin and calcium sulfate composite. The clinical and laboratory documents were evaluated. [Results] All 37 patients underwent successful surgery, with an average surgical time of (113.1±39.5) min and an average intraoperative blood loss of (156.8±78.3) mL, and were followed up for (38.3±22.8) months in a mean. Two patients had recurrent infection after surgery, which was controlled by revision of debridement and implantation of vancomycin calcium sulfate composite. All patients got bony healing in a mean of (7.9±2.9) months. With time that before operation, at discharge and the latest follow-up, the range of motion (ROM) of the knee [(39.4±7.3)°, (55.4±7.3)°, (106.1±17.3)°, P＜0.001] and KSS clinical score [(19.1±3.9), (30.0±2.7), (80.8±5.0), P＜0.001]、KSS functional score [(19.9±14.7), (38.8±4.9), (85.7±5.1), P＜0.001]、HHS score [(31.8±6.4), (40.0±5.4), (73.8±9.1), P＜0.001] were significantly increased. Regarding laboratory test, the CRP, WBC, and ESR significantly declined at discharge and the latest followup compared with those preoperatively, which returned to be normal in (5.4±2.5) weeks after the operation on an average. [Conclusion] According to the infection and fracture healing situation, debridement with retaining or removing the internal fixation by alternation of external fixator, and implantation of vancomycin-calcium sulfate composite in a timely manner are a reliable method for treating infection after internal fixation of tibial plateau fractures. It can effectively control infection and promote functional recovery.