Walenkamp G H, Kleijn L L, de Leeuw M
Department of Orthopedic Surgery, Academic Hospital Maastricht, The Netherlands.
Acta Orthop Scand. 1998 Oct;69(5):518-22. doi: 10.3109/17453679808997790.
We treated 100 patients having osteomyelitis with debridement and gentamicin-PMMA beads and followed them for 5 (1-12) years. 66 of the infections were chronic, in 18 cases combined with arthritis and in 3 cases with pseudarthrosis. They underwent 117 "treatment periods", consisting of one or more operations (total 152), in most cases with an interval of 2 weeks. No systemic antibiotics were necessary besides the local antibiotic treatment in 52 of the treatment periods. Healing was achieved in 92 patients, in 78 after a single treatment period which included 1-5 operations, in 14 after two or three treatment periods. Healing was more difficult to achieve when the infection was chronic, especially with a duration of more than 6 years or when caused by elective surgery. Local antibiotic treatment with gentamicin PMMA beads has the advantage that the wound can be closed primarily and that a higher local antibiotic concentration in the tissues can be achieved, often making systemic antibiotic treatment unnecessary.
我们对100例骨髓炎患者进行了清创术并植入庆大霉素-聚甲基丙烯酸甲酯（PMMA）珠，随访5（1 - 12）年。其中66例感染为慢性，18例合并关节炎，3例合并假关节。他们经历了117个“治疗周期”，每个周期包含一次或多次手术（共152次），多数情况下手术间隔为2周。在52个治疗周期中，除局部抗生素治疗外无需全身使用抗生素。92例患者实现愈合，其中78例在包含1 - 5次手术的单个治疗周期后愈合，14例在两个或三个治疗周期后愈合。当感染为慢性时，尤其是病程超过6年或由择期手术引起时，愈合更难实现。使用庆大霉素PMMA珠进行局部抗生素治疗的优点是伤口可一期闭合，且能在组织中达到更高的局部抗生素浓度，常常无需全身抗生素治疗。
