| 摘要: |
| ［摘要］ 目的 探讨万古霉素联合鼻环引流辅助胫骨横向骨搬移治疗足踝部慢性骨髓炎的效果及对炎症反应的影响。方法 招募2023年1月至2024年12月邯郸市第一医院收治的足踝部慢性骨髓炎患者148例，采用随机数字表法将其分为观察组和对照组，每组74例。对照组接受万古霉素联合传统骨搬移治疗，观察组接受万古霉素联合鼻环引流辅助胫骨横向骨搬移治疗。比较两组临床疗效、炎症指标、疼痛程度、治疗相关指标、耐甲氧西林金黄色葡萄球菌（MRSA）清除情况、术后并发症以及复发情况。结果 观察组骨愈合、功能维度的优良率显著高于对照组(98.65% vs 90.54%， χ2=4.757，P=0.029；97.30% vs 87.84%， χ2=4.812，P=0.028)。两组术后白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）水平均较术前降低，且观察组指标水平较对照组更低，差异有统计学意义（P<0.05）。两组术后视觉模拟量表（VAS）评分均较术前降低，但观察组评分较对照组更高，差异有统计学意义（P<0.05）。观察组术后万古霉素使用时间、创面愈合时间显著短于对照组（P<0.05），两组骨搬移时间差异无统计学意义（P>0.05）。观察组MRSA总清除率显著高于对照组（P<0.05）。随访6个月，观察组并发症总发生率显著低于对照组（4.05% vs 13.51%； χ2=4.132，P=0.042），两组复发率比较差异无统计学意义（6.76% vs 4.05%； χ2=0.132，P=0.716）。结论 万古霉素联合鼻环引流辅助胫骨横向骨搬移治疗足踝部慢性骨髓炎能有效控制炎症反应，促进患者快速康复，整体临床疗效良好。 |
| 关键词: 足踝部骨髓炎 万古霉素 鼻环引流 胫骨横向骨搬移 耐甲氧西林金黄色葡萄球菌 疗效 |
| DOI：10.3969/j.issn.1674-3806.2026.09.13 |
| 分类号:R 684.3 |
| 基金项目:邯郸市科学技术研究与发展计划项目（编号：1823208087ZC） |
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| Clinical efficacy of vancomycin combined with nose ring drainage-assisted transverse tibial bone transport in treating chronic osteomyelitis of the foot and ankle and its impact on inflammatory |
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Liu Qingchao, Yang Jinjie
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Department of Hand and Foot Surgery, Orthopedics Campus, Handan First Hospital, Handan 056002, China
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| Abstract: |
| ［Abstract］ Objective To investigate the clinical efficacy of vancomycin combined with nose ring drainage-assisted transverse tibial bone transport in treating chronic osteomyelitis of the foot and ankle and its impact on inflammatory response. Methods A total of 148 patients with chronic osteomyelitis of the foot and ankle who were admitted to Handan First Hospital from January 2023 to December 2024 were enrolled and randomly divided into an observation group(n=74) and a control group(n=74) by random number table method. The control group received vancomycin combined with conventional bone transport therapy, while the observation group received vancomycin combined with nose ring drainage-assisted transverse tibial bone transport therapy. The clinical efficacy, inflammatory indicators, degree of pain, therapy-related indicators, clearance rate of methicillin-resistant Staphylococcus aureus(MRSA), postoperative complications, and recurrence rate were compared between the two groups. Results The excellent and good rates for bone healing and functional recovery in the observation group were significantly higher than those in the control group(98.65% vs 90.54%, χ2=4.757, P=0.029; 97.30% vs 87.84%, χ2=4.812, P=0.028). The levels of white blood cell count(WBC), C-reactive protein(CRP), and interleukin-6(IL-6) in both groups after operation decreased compared with those before operation, and the indicator levels in the observation group were lower than those in the control group after operation, with statistically significant differences(P<0.05). Visual Analogue Scale(VAS) scores decreased postoperatively in both groups; however, the observation group exhibited higher VAS scores than the control group after operation, with statistically significant differences(P<0.05). The duration of vancomycin administration and wound healing time in the observation group were significantly shorter than those in the control group(P<0.05), whereas no significant difference was observed in the duration of bone transport between the two groups(P>0.05). The total MRSA clearance rate in the observation group was significantly higher than that in the control group(P<0.05). During the 6-month follow-up period, the total incidence of complications in the observation group was significantly lower than that in the control group(4.05% vs 13.51%; χ2=4.132, P=0.042), while there was no significant difference in recurrence rate between the two groups(6.76% vs 4.05%; χ2=0.132, P=0.716). Conclusion Vancomycin combined with nose ring drainage-assisted transverse tibial bone transport can effectively control inflammatory responses, promote rapid rehabilitation, and demonstrate favorable overall clinical outcomes in treatment of chronic osteomyelitis of the foot and ankle. |
| Key words: osteomyelitis of the foot and ankle vancomycin nose ring drainage transverse tibial bone transport methicillin-resistant Staphylococcus aureus(MRSA) clinical efficacy |
