| Background: Two antibiotic delivery system,antibiotics-loaded polymethyl methacrylate（PMMA）local delivery system and antibiotics-loaded calcium sulfate local delivery system,have been widely used for the treatment of chronic osteomyelitis with good efficacy.Both of them have their own advantages and disadvantages in clinical use,but the clinical efficacy of combination therapy with the two antibiotic delivery system in the treatment of chronic osteomyelitis has rarely been studied.Objective: In this study,we evaluated the feasibility and clinical efficacy of combination with vancomycin-loaded PMMA and vancomycin-loaded calcium sulfate in the treatment of chronic osteomyelitis by comparing with vancomycin-loaded calcium sulfate local delivery system.Methods: The data of 32 patients with chronic osteomyelitis admitted to the Department of Traumatology and Orthopaedics,Tahe Hospital affiliated to Hubei University of Medicine,from September 2013 to September 2021 were retrospectively analyzed.The treatment protocols were all based on complete debridement of the lesion in phase I combined with implantation of antibiotic delivery system,and the decision of bone grafting was made after the infection was completely controlled,depending on the bone defect.According to the different antibiotic delivery systems,15 patients were implanted with combination with vancomycin-loaded PMMA and vancomycin-loaded calcium sulfate as the study group and 17 patients were implanted with vancomycin-loaded calcium sulfate as the control group.The number of debridement procedures,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,liver and kidney function,blood calcium,incision healing,number of infection control,infection control time,number of infection recurrence,number of bone grafting,and bone healing time during treatment in both groups were recorded and analyzed statistically by SPSS25.0.Results:（1）The general data of the patients in the two groups were comparable,and the differences were not statistically significant（P>0.05）.（2）The study group showed no significant differences in the number of debridement procedures（1.87±0.64 in the study group vs.2.06±0.66 in the control group）,preoperative ESR（33.20±10.99 mm/h in the study group vs.30.35±10.06 mm/h in the control group）,CRP（23.07±7.88 mg/L in the study group vs.24.18±9.23 mg/L in the control group）,and number of bone graft（6 in the study group vs 7 in the control group）,and time to bony healing（9.33±2.16 months in the study group vs 10.71±1.80 months in the control group）were not statistically significant compared with the control group（P>0.05）.（3）ESR at 2 months postoperatively（6.93±2.15 mm/h in the study group vs8.71±2.26 mm/h in the control group）,CRP（5.93±2.09 mg/L in the study group vs8.00±2.15 mg/L in the control group）,incisional healing（13 grade A healing in the study group vs 9 grade A healing in the control group）,infection control rate（93.3% in the study group vs 82.3% in the control group）,infection control time（2.73±0.91 months in the study group vs.3.80±1.25 months in the control group）,and infection recurrence rate（0% in the study group vs.11.2% in the control group）in the study group were significantly better than those in the control group,with statistically significant differences（P<0.05）.Postoperative liver function and kidney function impairment and blood calcium abnormalities were not observed in both groups.Conclusion:（1）Thorough and effective debridement is the basis for the treatment of chronic osteomyelitis.（2）The combination with vancomycin-loaded PMMA and vancomycin-loaded calcium sulfate can safely and effectively treat chronic osteomyelitis.（3）Compared with vancomycin-loaded calcium sulfate,the combination with vancomycin-loaded PMMA and vancomycin-loaded calcium sulfate has better clinical efficacy in the treatment of chronic osteomyelitis and is more advantageous in controlling infection and reducing postoperative complications without increasing the number of operations,which is worthy of clinical promotion. |
PDF Full Text Request