Analysis Of The Efficacy Of Antibiotic-Loaded Calcium Sulfate Artificial Bone And Polymethyl Methacrylate (Bone Cement) In The Treatment Of Chronic Osteomyelitis

Objective: Analysis of the efficacy of vancomycin-loaded calcium sulfate artificial bone and polymethyl methacrylate(bone cement)in the treatment of chronic osteomyelitisMethods: Vancomycin calcium sulfate treatment group: There were a total of 17 patients in this group,including 14 males and 3 females.According to the anatomical location of the lesion of osteomyelitis,it could be roughly summarized as: 7 cases of tibia segment(1 case with ankle infection),6 cases of femur segment,3 cases of ulna segment(including 1 case of elbow osteomyelitis),and 1 case of fibula segment.Injury factors and external influences can be summarized as: 11 cases of traffic accidents,4 cases of falling injuries from height(2 meters or above the base level),2 cases of falling injuries.All the patients in this group had been admitted to hospital for surgical treatment after definite diagnosis of osteomyelitis once or twice in the past history: simple infection debridement in 5 cases,drainage and irrigation after debridement in 7 cases,and bone cement filling in 5 cases.In this group,bacterial culture of local soft tissues and secretions of lesions was taken before surgery,and bacterial drug sensitivity test was improved to guide drug use.The preoperative imaging findings,intraoperative findings and postoperative pathological diagnosis of chronic osteomyelitis were consistent.Control group mixed with vancomycin bone cement chain beads(PMMA): There were 11 patients in this group,including 8 males and 3females.In the same treatment group,according to the anatomical location of the lesion of osteomyelitis,it could be summarized as: 4 cases in the tibia segment,4 cases in the femur segment,1 case in the fibula segment,1 case in the iliac segment,and 1 case in the calcaneus.Cause of injury: traffic accident in 8 cases,fall in 3 cases.All the patients in this group had been admitted to hospital for surgery after definite diagnosis of osteomyelitis for 1～2 times in the past history: simple infection debridement in 4 cases,drainage and irrigation after debridement in 7cases.In this group,bacterial culture of local soft tissues and secretions of lesions was taken before surgery,and bacterial drug sensitivity test was improved to guide drug use.The control group was also diagnosed as chronic osteomyelitis according to preoperative imaging,intraoperative findings and postoperative pathology.Results: In the vancomycin calcium sulfate group,the average hospital stay was 17.1 days,the average operation time was 106.4minutes,the average blood loss was 110.6ml,the number of operations was less,the hospital stay was short,and the second-stage bone graft rate was low.The cure rate after first-stage operation was 88.23%(15/17),and the rate of reoperation was 11.76%(2/17).Two patients in this group received further surgical treatment(complete debridement again and packing with vancomycin calcium sulfate granules to control infection).Infection was eliminated in 1 of the 2 cases of recurrence,and the clearance rate of secondary infection was 94.12%(16/17).There was no persistent infection in this group.In the control group mixed with vancomycin polymethylmethacrylate(PMMA),the average hospital stay was 27.7days,the average operation time was 130.3 minutes,and the average blood loss was 157.3ml.4 patients had local infection control after operation.The infection clearance rate after one-stage operation was54.55%(6/11),and the reoperation rate was 45.45%(5/11).One patient with persistent or recurrent infection was cured,and the clearance rate of secondary infection was 63.64%(7 /11).The reoperation rate was higher in thecontrolgroupmixedwithvancomycin polymethylmethacrylate(PMMA)(4 cases in the control group,1 cases in the study group,λ~2=4.043,P=0.044)The results of univariate analysis showed that there was no significant difference in sex,age,intraoperative blood loss and operation time between the two groups(λ~2/t=0.368,1.127,1.758,1.156;P > 0.05),but there were significant differences in operation times,hospital stay and secondary bone grafting between the two groups(t=3.571,2.817,6.601;P < 0.05).Conclusion:1.Calcium sulfate cementloaded with vancomycin can control infection progress,reduce disease recurrence rate,avoid the trauma caused by the second operation,shorten treatment cycle,and achieve the clinical effect of drug loading therapy and bone tissue reconstruction in the treatment of chronicoste omyelitis.2.Mixedvancomycin polymethyl-methacrylate(PMMA)is a traditional treatment,especially for osteomyelitis with poor skin and soft tissue conditions.It has its unique advantages,which can be retained for a long time,even in the absence of skin and soft tissue coverage,it can fill the defect for a long time and create conditions for the soft tissue wound coverage in the later stage.