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抗生素混合骨水泥填充治疗慢性骨髓炎

Antibiotic-Mixed Cement Filling for Chronic Osteomyelitis.

作者信息

Park Seung-Hwan, Choi Young Rak, Jeong Inyong, Lee Ho Seong

机构信息

Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.

出版信息

J Pers Med. 2025 May 6;15(5):187. doi: 10.3390/jpm15050187.

Abstract

Traditional treatment for chronic osteomyelitis is temporary implantation of antibiotic-impregnated cement beads, followed by bone grafting after the infection is controlled. In this way, a staged operation is needed, and undergoing repetitive general anesthesia is a burden. Moreover, damage to the soft tissue at the surgical site due to several incisions is a concern. This study was conducted to investigate the outcomes of one-stage antibiotic-mixed cement blocks, instead of beads, used as a primary salvage procedure to treat chronic osteomyelitis of the foot, ankle, and lower leg. Twenty patients with chronic osteomyelitis of the leg and foot were included. They underwent complete debridement of the infected bone, and antibiotic-mixed cement fillings were placed into the defected bone space. Full-weight-bearing activities were allowed immediately after surgery. For 16 of the 18 patients, infection was controlled after one-time surgery. Repeat antibiotic cement-filling surgery was necessary for two patients. Two-staged surgery with continuous irrigation and cement filling was necessary for one large tibial lesion. Conversion into arthrodesis of the metatarsophalangeal joint was necessary for metatarsal head infection. : One-stage surgery with complete debridement and antibiotic-mixed cement filling is a simple and effective procedure for treating intractable chronic osteomyelitis, which makes full-weight-bearing walking possible immediately after surgery.

摘要

慢性骨髓炎的传统治疗方法是临时植入含抗生素的骨水泥珠,待感染得到控制后再进行骨移植。通过这种方式,需要进行分期手术,并且反复接受全身麻醉是一种负担。此外,多次切开导致手术部位软组织受损也是一个问题。本研究旨在调查采用一期抗生素混合骨水泥块(而非骨水泥珠)作为主要挽救手术治疗足、踝及小腿慢性骨髓炎的效果。纳入了20例小腿和足部慢性骨髓炎患者。他们接受了感染骨的彻底清创,并将抗生素混合骨水泥填充物置入骨缺损处。术后立即允许完全负重活动。18例患者中有16例经一次性手术后感染得到控制。2例患者需要重复抗生素骨水泥填充手术。1例较大的胫骨病变患者需要进行持续冲洗和骨水泥填充的二期手术。跖骨头感染患者需要改行跖趾关节融合术。一期彻底清创并抗生素混合骨水泥填充手术是治疗难治性慢性骨髓炎的一种简单有效的方法,术后可立即实现完全负重行走。

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