| Objective To investigate the clinical efficacy of vancomycin-containing cement spacer combined with bone marrow stem cell enrichment technique in the treatment of post-traumatic bone infection.Methods A retrospective case series study was performed to analyze 42 patients with bone infection after calcaneal trauma from February 2012 to December 2017,including 25 left foot,13 right foot,and 4 bilateral.The age is 20 to 59 years old and the average age is 43 years old.After the injury to the operation time of 1 to 30months(average 11.5 months).Staged treatment was used.After stage I thorough debridement,vancomycin cement spacer was used to fill the bone defect to treat infection.In stage II,bone marrow mesenchymal stem cell enrichment technique combined with allogeneic bone was used to treat bone defect after infection.Postoperative dynamic observation of patients with white blood cells(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and interleukin-6(IL-6),clinical manifestations of the affected limb(redness and heat pain and sinus formation),X-ray Sheet(side position and axial position).The visual pain simulation score(VAS score)and the American Foot and Ankle Surgery Association’s hind foot score(AOFAS-AH)were used to evaluate postoperative limb function and to observe wound healing and complications.The data was analyzed using statistical software SPSS22.0Results All patients were followed up for 12 to 48 months with an average of 20.5months.The postoperative function of 42 patients recovered well.The inflammatory index was reviewed 1 month after operation.The WBC decreased from preoperative(10.85±5.24)×109/L to(8.35±2.70)×109/L,and ESR was preoperatively(27.45±25.52)mm/h decreased to(6.21±3.20)mm/h,CRP decreased from preoperative(11.43±9.32)mg/L to(3.26±1.84)mg/L,and IL-6 was preoperative(7.25± 5.24)ng/L drops to(4.34 ± 2.17)ng / L.The AOFAS-AH score was improved from preoperative(38.43 ± 3.72)points to(50.15 ± 7.38)points at 1 month postoperatively and(65.51 ± 2.93)points at 6 months postoperatively.After 42 patients were treated with antibiotic cement spacer in stage I,4 patients(9%)had recurrence after recurrence of vancomycin cement spacer after recurrence of infection.The cure rate of bone infection was 91(38/42).5 cases(12%)patients had pain in the postoperative foot.After 6-8 weeks,allogeneic bone-binding bone marrow mesenchymal stem cell enrichment technique was used for bone grafting.All patients were 6-24 months after operation.(Average 10 months)Get bone healing and eventually resume the original work.Conclusion We believe that vancomycin cement spacers are ideal for use in stage I debridement surgery when using vancomycin cement spacers to treat bone infections after calcaneus trauma.Compared with the traditional method,this method can partially eliminate dead space,release high concentration antibiotics,kill planktonic bacteria and induce highly vascularized biofilm.Phase II uses allogeneic bone-binding stem cell enrichment technology to treat post-infected bone.Defect.Compared with autologous bone,it can effectively avoid the continuous pain,infection,tibia fracture,heterotopic ossification,pelvic stability damage and other problems in the autogenous bone donor area.The combination of the two is a new method for treating bone infection after calcaneal trauma... |
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