| 吕辉照,梁志白,张爱玲,等.定制化敏感抗生素骨水泥螺钉治疗踝关节术后感染的临床研究.骨科,2023,14(5): 434-439. |
| 定制化敏感抗生素骨水泥螺钉治疗踝关节术后感染的临床研究 |
| Effect of Customized Cement Screws with Sensitive Antibiotics for Postoperative Ankle Infection |
| 投稿时间：2023-07-17 |
| DOI：10.3969/j.issn.1674-8573.2023.05.008 |
| 中文关键词: 踝关节 术后感染 抗生素骨水泥 骨水泥螺钉 定制化 敏感抗生素 |
| 英文关键词: Ankle Postoperative infection Antibiotic cement Cement screw Customized Sensitive antibiotics |
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| 中文摘要: |
| 目的 评估定制化敏感抗生素骨水泥螺钉治疗踝关节术后感染的疗效。方法 回顾性分析2017年3月至2022年7月收治的22例踝关节术后感染病人的临床资料，其中男12例，女10例；年龄为（39.27±5.78）岁（31~52岁）。按内固定方式不同分为两组。观察组10例，采用定制化敏感抗生素骨水泥螺钉内固定；对照组12例，采用钛质克氏针和/或外固定架固定。记录两组病人伤口愈合等级、感染复发率、感染指标［降钙素原（procalcitonin，PCT）、白细胞计数（white blood cell count，WBC）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reactive protein，CRP）］、影像学特征等内容。结果 观察组伤口均甲级愈合，感染复发率为0，优于对照组（P＜0.05）。两组间的总体PCT、WBC、ESR、CRP比较，差异无统计学意义（P＞0.05），但对照组术后6个月的PCT、WBC和CRP均高于观察组（P＜0.05）。术后6个月观察组的踝关节融合率为50.00%（5/10），优于对照组的16.67%（2/12）（P＜0.05）。两组间在滑膜增厚、关节积液及软组织肿胀方面比较，差异无统计学意义（P＞0.05），但观察组在骨髓水肿、钉道增宽水肿方面优于对照组（P＜0.05）。观察组未出现内固定松动、断裂现象，而对照组虽未出现内固定断裂病例，但6例出现克氏针松动，两组间的内固定物松动率比较，差异有统计学意义（P＜0.05）。结论 踝关节术后感染采用定制化敏感抗生素骨水泥螺钉内固定，既可增强局部抗感染能力，减少感染复发率，还可提高术后关节稳定性，减少二次融合手术率，可能是一种值得推荐的方法。 |
| 英文摘要: |
| Objective To evaluate the effect of customized cement screws with sensitive antibiotics for postoperative ankle infection. Methods A retrospective analysis was performed on the clinical data of 22 patients with postoperative infection of the ankle joint admitted from March 2017 to July 2022, including 12 males and 10 females. The age was (39.27±5.78) years old (31-52 years old). According to method of internal fixation, 10 patients in observation group were given customized cement screws with sensitive antibiotics, and 12 patients in control group were subjected to the K-wires and/or external fixator. Grade of wound healing, recurrence rate of infection, indicators of infection ［procalcitonin (PCT), white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)］ and imaging characteristics were recorded. Results Grade of wound healing and recurrence rate of infection in the observation group were superior to the control group (P＜0.05). There were no significant differences between two groups in total PCT, WBC count, ESR and CRP (P＞0.05), but PCT, WBC count and CRP at 6th month postoperatively in the control group were higher than those in the observation group (P＜0.05). Rate of ankle fusion at 6th month in the observation group ［50.00% (5/10)］ was superior to the control group ［16.67% (2/12)］ (P＜0.05). Thickened synovial membrance, hydrops articuli, soft tissue swelling in the observation group were the same as those in the control group (P＞0.05), but bone marrow edema and widened nail path in the observation group were superior to those in the control group (P＜0.05). There was no loose internal fixator in the observation group, and 6 K-wires loosed in the control group were found. There was significant difference between two groups (P＜0.05). Conclusion Using customized cement screws with sensitive antibiotics for postoperative ankle infection, could enhance local anti-infective function and decrease recurrence rate of infection, and increase instability of ankle and then decrease secondary fusion rate. It may be a recommendable method. |
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