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Efficacy Analysis Of Antibiotic-Loaded Calcium Sulfate Combined With Short-Term And Long-Term Systemic Antibiotics In The Treatment Of Tibial Osteomyelitis

Posted on:2024-03-22Degree:MasterType:Thesis
Country:ChinaCandidate:S JiFull Text:PDF
GTID:2544307061481004Subject:Surgery
Abstract/Summary:PDF Full Text Request
Objective: To compare the clinical efficacy of antibiotic-loaded calcium sulfate combined with short-term and long-term systemic antibiotics in the treatment of tibial osteomyelitis,and to explore whether antibiotic-loaded calcium sulfate can help shorten the application time of systemic antibiotics in patients with tibial osteomyelitis.Methods: A total of 44 patients with chronic tibial osteomyelitis treated by debridement combined with antibiotic-loaded calcium sulphate technique were included in this study according to the inclusion and exclusion criteria,and were treated with systemic antibiotics for 2 or 6 weeks after surgery.There were 27 men and 17 women;age ranged from 23 to 64 years,mean 42.7±9.1 years;Cierny-Mader typing of osteomyelitis: typeⅡaccounted for 16.9%,type III accounted for 50.0%,and type IV accounted for 34.1%;causes of infection: traumatic in 39 cases and hematogenous in 5cases.Postoperatively,24 cases underwent 2 weeks of systemic antibiotic therapy(short-term group)and 20 cases underwent 6 weeks of systemic antibiotic therapy(long-term group).The distribution of causative organisms,Indicators of inflammation and wound healing infection control rate,occurrence of adverse drug reactions and abnormal liver and kidney function were compared between the two groups,and finally the clinical data of the two groups were statistically analyzed.Results: All patients were followed up for a mean of 24.8(12-36)months.Inflammatory indexes: there was no significant difference in inflammatory indexes(WBC,ESR and CRP)between the two groups 2 months after operation.Wound condition: 9 patients had aseptic exudation,2 patients had red and swollen wound with purulent exudation,and 1 patient had slight necrosis at the edge of the flap.there was no significant difference in wound healing time between the two groups.Infection control:39 patients(39/44,88.6%)achieved remission of tibial osteomyelitis infection without recurrence.There was no significant difference in infection control rate between the two groups(P > 0.05).5 patients(11.4%)had recurrence of infection,with a mean recurrence time of 63.4(32-107)days,3 in the short-term group and 2 in the long-term group.Among them,2 cases of external fixation pin infections and 1 case of deep infection occurred in the short-term group,and 1 case of fixed needle tract infection and 1 case of deep infection occurred in the long-term group.Recurrent cases were treated with secondary debridement combined with anti-infection therapy,and the infections were well controlled at the final follow-up and no recurrence was seen.Adverse drug reactions:3 patients in the long-term group had gastrointestinal symptoms such as nausea and diarrhea.The rates of abnormal postoperative liver and kidney function 4.2%(1/24)and gastrointestinal irritation 0.0%(0/24)were lower than those of patients in the long-term group 15.0%(3/20)and 15.0%(3/20),but the differences were not statistically significant(P > 0.05).The rate of adverse drug reactions in the short-term group was4.2%(1/24)lower than that in the long-term group 30.0%(6/20),and the difference was statistically significant(P < 0.05).Conclusion: Adequate debridement combined with long-term systemic antibiotic therapy is the most traditional treatment for tibial osteomyelitis.However,this study found that adding antibiotic-loaded calcium sulfate during debridement,and only 2weeks of systemic antibiotic treatment after surgery can achieve similar infection control effects as 6 weeks of systemic antibiotic treatment.It also reduces the risk of adverse reactions and liver and kidney function damage caused by long-term use of antibiotics.Therefore,the application of antibiotic calcium sulfate may shorten the systemic application time of antibiotics to 2 weeks in patients with tibial osteomyelitis.
Keywords/Search Tags:Osteomyelitis, Systemic antibiotic therapy, Local antibiotic therapy, Calcium sulfate, Adverse drug reactions
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