糖尿病足导致跟骨骨髓炎继发跟骨病理性鸟嘴样骨折的治疗效果
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作者Author单位AddressE-Mail
李炜峰 LI Wei-feng 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China liweifeng0113@qq.com 
高彦军 GAO Yan-jun 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China  
王士波 WANG Shi-bo 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China  
阮培灿 RUAN Pei-can 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China  
邱元洲 QIU Yuan-zhou 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China  
何昌强 HE Chang-qiang 深圳市罗湖区中医院创伤骨科与足踝外科, 广东 深圳 518001 Department of Traumatic Orthopaedics & Foot and Ankle Surgery, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong, China  
期刊信息:《中国骨伤》2024年,第37卷,第6期,第609-615页
DOI:10.12200/j.issn.1003-0034.20230327
基金项目:深圳市"医疗卫生三名工程"项目(编号:SZZYSM202101005);深圳市罗湖区软科学研究项目(编号:LX202202034,LX202202037)
中文摘要:

目的: 探讨万古霉素硫酸钙联合内固定治疗糖尿病足导致跟骨骨髓炎继发跟骨病理性"鸟嘴样"骨折的临床疗效。

方法: 回顾性分析2018年4月至2021年10月收治的5例糖尿病足导致跟骨骨髓炎继发跟骨病理性"鸟嘴样"骨折患者,男2例,女3例;年龄48~60岁;糖尿病病程5~13年;糖尿病足病程18~52 d;按Wagner分级均为Ⅲ级。所有患者根据病情Ⅰ期实施清创术,万古霉素骨水泥植入,负压吸引术;Ⅱ期使用万古霉素硫酸钙加内固定治疗跟骨病理性"鸟嘴样"骨折。记录患者手术切口、骨折愈合时间,观察骨髓炎复发情况,评价术后12个月美国足与踝关节协会踝与后足评分(American Orthopedic Foot Andankle Society,AOFAS)及渗出等并发症情况。

结果: 5例顺利完成手术,所有患者未出现下肢血管闭塞。5例获得随访,时间16~36个月。骨折内固定术后切口愈合时间16~26 d,所有骨折愈合,愈合时间16~27周。术后12个月AOFAS评分65~91分;其中优2例,良2例,可1例。其中1例术后5个月因烫伤导致足背部皮肤溃疡(非并发症),经治疗后痊愈;2例出现伤口渗漏并发症,经换药后伤口痊愈;所有患者未再发骨髓炎及骨折。

结论: 万古霉素硫酸钙联合内固定治疗糖尿病足导致跟骨骨髓炎继发跟骨病理性"鸟嘴样"骨折在控制感染的同时可促进骨折愈合,可获得较好的临床效果。
【关键词】糖尿病足  病理性骨折  骨髓炎  万古霉素骨水泥  万古霉素硫酸钙
 
Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot
ABSTRACT  

Objective To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot.

Methods From April 2018 to October 2021,a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot,including 2 males and 3 females,aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement,vancomycin bone cement implantation,negative pressure aspiration at stageⅠ,vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded,and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated.

Results Five patients were successfully completed operation without lower extremity vascular occlusion,and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days,and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation,and 2 patients got excellent result,2 good and 1 fair. Among them,1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication),was recovered after treatment;the wound leakage complication occurred in 2 patients,and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients.

Conclusion Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection,but also promote fracture healing,and obtain good clinical results.
KEY WORDS  Diabetic foot  Pathological fracture  Osteomyelitis  Vancomycin bone cement  Vancomycin calcium sulfate
 
引用本文,请按以下格式著录参考文献:
中文格式:李炜峰,高彦军,王士波,阮培灿,邱元洲,何昌强.糖尿病足导致跟骨骨髓炎继发跟骨病理性鸟嘴样骨折的治疗效果[J].中国骨伤,2024,37(6):609~615
英文格式:LI Wei-feng,GAO Yan-jun,WANG Shi-bo,RUAN Pei-can,QIU Yuan-zhou,HE Chang-qiang.Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(6):609~615
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