| 郑昊.抗生素骨水泥治疗糖尿病并发下肢坏死性筋膜炎的疗效观察[J].浙江中西医结合杂志,2025,35(3): |
| 抗生素骨水泥治疗糖尿病并发下肢坏死性筋膜炎的疗效观察 |
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| 投稿时间：2024-06-27 修订日期：2024-11-10 |
| DOI： |
| 中文关键词: 糖尿病 坏死性，筋膜炎 外科清创术 骨水泥 |
| 英文关键词:diabetes mellitus Necrotizing Fasciitis Debridement Bone cement |
| 基金项目:杭州市医药卫生科技项目(A20200297)；2023中西医协同创新基金。 |
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| 中文摘要: |
| ［］目的: 观察抗生素骨水泥在治疗糖尿病并发下肢坏死性筋膜炎中的临床效果。方法: 回顾性分析浙江省龙游县人民医院和浙大邵逸夫医院2019年1月至2023年6月收治的18例糖尿病并发下肢坏死性筋膜炎患者的临床资料,其中男14例,女4例；年龄29～75岁,感染部位:足部12例,小腿部位3例,全下肢3例；患者经急诊评估后行切开探查清创引流术,清创后用含万古霉素和庆大霉素的骨水泥填塞空腔、覆盖创面,待全身及肢体局部感染得到控制、创面新鲜肉芽生长后行二次手术取出骨水泥,根据创面具体情况选择闭合创面或行植皮修复术。观察并统计清创手术次数,感染指标下降情况及创面愈合情况,出院后随访复发情况。结果:本组18例患者中11例行1次清创后创面感染即得到控制,5例经2次清创后感染控制,此16例患者后续进行植皮等操作后创面愈合；余2例,1例行大腿截肢,1例行小腿截肢。患者住院天数为18～37d。患者出院后随访3～6个月,未出现坏死性筋膜炎复发。结论:糖尿病合并坏死性筋膜炎病程进展快,有较高的致残率,使用抗生素骨水泥治疗能有效控制感染、促进创面愈合。 |
| 英文摘要: |
| Objective: To explore the clinical efficacy of antibiotic bone cement in treating diabetes mellitus complicated with necrotizing fasciitis . Methods :A retrospective analysis of 18 diabetes mellitus complicated with necrotizing fasciitis patients who were admitted to the Sir Run Run Shaw Hospital from January 2019 to June 2023, including 14 males and 4 females, aged 29 to 75 years. Main pathological process started in foot in 12 patients, in shank in 3 patients, in lower extremity in 3 patients. Extensive incision and drainage was achieved timely in 18 patients combined with debridement. The wound surface and dead space was filled with bone cement containing gentamicin and vancomycin. After there was no obvious infection on the wound and fresh granulation tissue growth, the bone cement was removed and wound repair surgery was performed by suture or skin grafting.? The times of debridement, infection control, wound healing, total hospitalization day, and recurrence of necrotizing fasciitis during follw-up were recorded. Results: 11 patients had wound infection control with once debridemen surgery, 5 patients had wound infection control after twice debridemen surgery, this 16 patient’s wounds were directly tissued or repaired with split-thickness skin grafts , 2 patients showed a large area of skin necrosis and amputation was selected. The total hospitalization day of patients was 18～37 days. Follow-up for 3～6 months showed no recurrence of necrotizing fasciitis in any patient. Conclusions: Diabetes mellitus complicated with necrotizing fasciitis which is acute and progressing rapidly, antibiotic bone cement can effectively control infection and promote wound healing. |
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