Comparison Of The Effects Between VSD Joint Vancomycin Beads Implanted And Antibiotic Irrigation Drainage In The Treatment Of Chronic Osteomyelitis

Purpose:Through comparison of effect between VSD joint vancomycin bead implanted and antibiotic washing drainage cooperating with surgical treatment in the treatment for chronic osteomyelitis, explore the effective method for the treatment of chronic osteomyelitis.Meterials and Methods:This study retrospectively analysed32patients with G+chronic osteomyelitis treated in the Department of Orthopaedic Surgery, of clinical hospital between January2007and October2011.There were19males,13females, with an average age of32.3years (range,17-65years)., The average course of infection was6.7months (range, lmonths-4.5years). Among these patients28cases from fractures posto-perative infection with implants and4cases from blood-borne osteomyelitis. The32wounds including:7femoral,16tibia,1fibula,3calcaneus,2radius,3humerus; All of these patients had an active infection, and29cases had a draining sinus on admission,5cases had skin soft tissure defect with bone exposed. The bacterial species culture that performed by direct biopsy from the involved bone, detected6bacteriums of positive of pathogenic bacteria amounting to37plants that were consisted of:23Staphylococcus aureus,7methicillin-resistant staphylococcus,2Staphylococcus haemolyticus,1Staphylococcus haemolyticus,3hemolytic streptococcus,1enterococcus faecium. Based on Cierny-Mader type classification:Ⅱ A5cases, Ⅱ B1cases, ⅢA13cases,ⅢB6cases, ⅢC2cases, ⅣA3cases, ⅣB2cases. According to the treatmeng of chronic osteomyelitis32cases were divded into the experimental group with17cases and the control group with15cases. The main surgical procedure in the experimental group comprosed:radical debridement, removing the implants stabilized with appropriate hardware, VSD, vancomycin-impregnated beads chain implanted and culture-specific systemic antibiotics. In the control group mainly consisted of:debridement, implants removed, mass antibiotics saline irrigation, and long-term systemic antibiotics. The evaluated indexs included:cure rate, recurrence rate, germiculture positive potive rate, systemic antibiotic use time, healing time, totle hospital stay.Results:The mean follow-up was currently1.5years (range:6months-3.5years). The experimental group:14cases cured,3cases improved,1case of recurrence. Wound averaged2.8(range:1-4)VSD sponges changes. Before the wound closure, the intramedullary bacteria cultivation turned out to be positive only in1wounds. The final wound were direct suture closure for13cases,4wounds for flap transfer. The control group:7cases cured,5cases improved,3cases still bad,4cases of recurrence. Wounds averaged3.6(range:1-4) debridements. Before the wound closure, the intramedullary bacteria cultivation turned out to be positive in5wounds. The final wound were direct suture closure for6cases,9wounds for flap transfer. To two sets of data from both treatment groups were analyzed statistically. Including:cure rate, recurrence rate, germiculture positive rate, systemic antibiotic use time, healing time, totle hospital stay(P<0.05), there were significant statistical difference between the two groups.Conclusion:Through the comparison of the methods between the two therapies. VSD can promote the granulation tissue formation,oedema reduction and bacterial clearance, avoid the need for flaps transfer. Vancomycin bead implanted medullary cavity could kill bacterial effectively, decrease the application systemic antibiotic and reduce inflection recurrence in patients. Antibiotics irrigation was easily jamed, leading to poor drainage.sterilization wasn’t complete resulting in recurrence, long-term applicition of systemic antibiotic body were likely to generate resistance and so on. The results showed that VSD joint vancomycin bead implanted combined appropriate surgical therapy represents an effective treatment of chronic osteomyelitis caused by gram-positive bacterium. It may be more suitable for treating chronic osteom-yelitis with soft tissue problems.