切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 163 -166. doi: 10.3877/cma.j.issn.1674-1358.2020.02.014

所属专题: 经典病例 经典病例 文献

短篇论著

万古霉素复合型抗菌药物骨水泥植入治疗22例骨科术后感染者的疗效
何勇1,(), 叶剑锋1, 简盛生1   
  1. 1. 518001 深圳市,深圳市罗湖区人民医院骨外科
  • 收稿日期:2019-06-05 出版日期:2020-04-15
  • 通信作者: 何勇

Efficacy of vancomycin compound antibiotic bone cement implantation in the treatment of 22 cases with postoperative orthopedic infection

Yong He1,(), Jianfeng Ye1, Shengshen Jian1   

  1. 1. Department of Orthopaedic Surgery, Luohu District People’s Hospital, Shenzhen 518001, China
  • Received:2019-06-05 Published:2020-04-15
  • Corresponding author: Yong He
  • About author:
    Corresponding author: He Yong, Email:
引用本文:

何勇, 叶剑锋, 简盛生. 万古霉素复合型抗菌药物骨水泥植入治疗22例骨科术后感染者的疗效[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(02): 163-166.

Yong He, Jianfeng Ye, Shengshen Jian. Efficacy of vancomycin compound antibiotic bone cement implantation in the treatment of 22 cases with postoperative orthopedic infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(02): 163-166.

目的

观察万古霉素复合型抗菌药物骨水泥植入治疗骨科术后感染的疗效。

方法

选择深圳市罗湖区人民医院骨科2016年1月至2017年12月收治的22例骨科术后感染者为研究对象,给予万古霉素复合型抗菌药物骨水泥植入术治疗,并对疗效进行评价。

结果

入组患者中20例炎性组织、肉芽培养出致病菌,2例患者未培养出致病菌。其中耐甲氧西林金黄色葡萄球菌占40%(8/20),表皮葡萄球菌占30%(6/20),肺炎克雷伯菌、铜绿假单胞菌和山羊葡萄球菌分别占15%(3/20)、10%(2/20)和5%(1/20)。22例患者首次手术与万古霉素复合型抗菌药物骨水泥链珠植入术间隔时长16~750 d,链珠在体内存留时长44~422 d。万古霉素复合型抗菌药物骨水泥植入术后均定期门诊随访4~15个月,其中感染控制者21例(95.45%),治愈者21例(95.45%),感染控制率和治愈率均为95.45%(21/22)。

结论

万古霉素复合型抗菌药物骨水泥植入术治疗骨科感染疗效确切,可作为骨科术后感染治疗的首选方法。

Objective

To investigate the efficacy of vancomycin compound antibiotic bone cement implantation on treatment of postoperative orthopedic infection.

Methods

Total of 22 patients with postoperative infection in Orthopedics Department of Luohu District People’s Hospital in Shenzhen City from January 2016 to December 2017 were seleced. All of them were treated with the vancomycin compound antibiotic bone cement implantation, and the efficacy was evaluated.

Results

The pathogenic bacteria were cultured from the inflammatory tissue and granulation of 20 patients, among which 40% (8/20) were methicillin-resistant Staphylococcus aureus (MRSA), 30% (6/20) were Staphylococcus epidermidis, 15% (3/20) were Klebsiella pneumoniae, 10% (2/20) were Pseudomonas aeruginosa and 5% (1/20) was Staphylococcus capillaries. The interval between the first operation of 22 patients and the implantation of vancomycin compound antimicrobial bone cement beads was 16-750 d, while the retention time of the beads in vivo was 44-422 d. All patients were followed up for 4-15 months after vancomycin compound antibiotic bone cement implantation, among whom, 21 cases (95.45%) were with infection controlled, 21 cases (95.45%) were cured, 1 case (4.55%) was not with infection controlled, and the infection control rate and cure rate were both 95.45% (21/22).

Conclusion

Vancomycin compound antibiotic bone cement implantation is effective in treatment of orthopaedic infection, it could be used as the first choice for the treatment of orthopedic postoperative infection.

表1 22例骨科术后感染者感染病原菌的构成
图1 典型患者胫腓骨骨感染行万古霉素复合型抗菌药物骨水泥植入术前与术后表皮
图2 典型患者左胫腓骨骨感染术后植入抗菌药物链珠后X平片
[1]
陈志城,谢伟贤,黄杰. 骨科术后感染中C反应蛋白和红细胞沉降率的应用价值[J]. 检验医学与临床,2019,16(7):976-978.
[2]
Harrasser N, Gorkotte J, Obermeier A, et al. A new model of implant-related osteomyelitis in the metaphysis of rat tibiae[J]. BMC Musculoskeletal Disorders,2016,17(1):1-11.
[3]
刘文清,李岩,李彦. 骨科老年患者术后医院感染危险因素分析[J]. 中国矫形外科杂志,2018,26(24):2250-2253.
[4]
吴丽红,师靓,李刚, 等. 骨科手术患者术后医院感染相关因素分析[J]. 中华医院感染学杂志,2018,28(20):3120-3123.
[5]
毛璐,张伯松,姜璐, 等. 载万古霉素骨水泥的人体局部释放及全身药物浓度监测[J]. 中国医院药学杂志,2019,39(3):244-246.
[6]
方栋,孙良业,谢肇. 载万古霉素骨水泥间隔器治疗跟骨创伤后骨感染的疗效[J]. 中华创伤杂志,2019,35(2):109-114.
[7]
Darren de SA, Cargnelli S, Catapano M, et al. Efficacy of hip arthroscopy for the management of septic arthritis: A systematic review[J]. Arthroscopy,2015,31(7):1358-1370.
[8]
刘杨,徐佳元,杨成林, 等. 万古霉素磷酸钙骨水泥治疗慢性骨髓炎的临床效果分析[J]. 解放军预防医学杂志,2018,36(7):876-878.
[9]
Wu K, Wang CS, Wang QG, et al. Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures[J]. J Res Med Sci,2014,19(6):495.
[10]
郭旭锋,刘勇军,高宏伟, 等. 万古霉素复合型抗菌药物骨水泥植入术疗法对骨科术后感染的疗效[J/CD]. 中华实验和临床感染病杂志(电子版),2018,12(2):189-192.
[11]
Ochsner PE, Hailemariam S. Histology of osteosynthes is associated bone infection[J]. Injury,2006,37(12):49-58.
[12]
黄剑,李基民,陈益, 等. 臀上动脉穿支螺旋桨肌皮瓣联合万古霉素骨水泥治疗骶尾部Ⅳ期压疮疗效分析[J]. 中华显微外科杂志,2019,42(1):61-64.
[13]
Giavaresi G, Borsari V, Fini M, et al. Preliminary investigations on a new gentamiein and vancomycin coated PMMA nail for the treatment of bone and intramedullary infections: An experimental studyin the rabbit[J]. Orthop Res,2008,26(6):785-792.
[14]
滕立初,陈拓,陈涤新, 等. 万古霉素骨水泥在脊柱内固定术后感染患者的临床应用[J]. 颈腰痛杂志,2018,39(3):371-372.
[15]
Conway JD, Hlad LM, Bark SE. Antibiotic cement-coated plates for management of infected fractures[J]. Am J Orthop,2015,44(2):49-53.
[16]
张彦龙,冯晨晨,田书伟, 等. 扩髓清创联合抗生素骨水泥髓腔植入治疗髓内钉术后感染[J]. 中华骨科杂志,2018,38(9):523-529.
[17]
郎志刚,袁峰,梁玉祥, 等. 载万古霉素磷酸钙骨水泥一期植入治疗慢性骨髓炎的疗效观察[J]. 华西医学,2017,32(12):1859-1862.
[18]
甘先民,侯悦媚,黄乙勇, 等. 不同成分骨水泥植入对胫骨慢性骨髓炎患者的临床疗效评价[J]. 中华医院感染学杂志,2017,27(12):2763-2766.
[19]
于强,田京. 抗生素骨水泥占位器在膝关节假体周围感染二期翻修中的应用[J]. 中国组织工程研究,2018,22(31):5048-5055.
[20]
张贵春,郑润泉,邹林, 等. 抗生素骨水泥联合llizarov技术在长骨感染性骨缺损治疗中的应用[J]. 实用骨科杂志,2019,25(1):25-28, 54.
[1] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[2] 王桂冠, 徐杰. 运动学对线在全膝关节置换术中的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 726-731.
[3] 张华, 孙宇, 乡世健, 李樱媚, 王小群. 循环肿瘤细胞预测晚期胃肠癌患者化疗药物敏感性的研究[J]. 中华普通外科学文献(电子版), 2023, 17(06): 422-425.
[4] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[5] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[6] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[7] 汪毅, 许思哲, 任章霞. 胸乳入路腔镜单侧甲状腺叶切除术与开放手术对分化型甲状腺癌患者术后恢复的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 542-545.
[8] 张蔚, 李杨, 尚培中, 尚丹丹, 张伟. TAPP术中切除成人隐睾转换迷你腹腔镜取出一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 586-587.
[9] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[10] 邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.
[11] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[12] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[13] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[14] 高显奎, 赵太云, 陆兴俊, 张洪领, 房修罗, 闫碧春, 王胤, 王永翠, 刘苗苗, 冉若男. 内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 452-455.
[15] 李莹倩, 李华山. 基于真实世界的完全性直肠脱垂治疗方式评价[J]. 中华临床医师杂志(电子版), 2023, 17(06): 700-705.
阅读次数
全文


摘要