目的 观察负载抗生素的骨移植物特性,比较不同骨移植物抗菌能力和成骨效果.方法 双侧胫骨近端慢性骨髓炎造模成功后,48只兔随机均分为4组接受治疗:A组:胫骨病灶清创并万古霉素皮下注射;B组:胫骨病灶清创并以预制的硫酸钙万古霉素颗粒填充清创后遗留的空腔;C组:胫骨病灶清创并以预制的磷酸钙万古霉素颗粒填充清创后遗留的空腔;D组:胫骨病灶清创并以预制的同种异体脱钙骨万古霉素颗粒填充清创后遗留的空腔.在胫骨病灶清创术后1、2、3个月末,每组各处死动物4只,解剖尸体并取胫骨纵剖两半行细菌学检查及病检.结果 B与C组及A与D组间细菌阳性率无统计学差异,而B、C组细菌阳性率低于A、D组.成骨能力:A组成骨比例低于其余各组,B、C、D组间成骨比例无统计学差异;2、3个月末成骨比例,A组＜B组、D组＜C组.结论 负载万古霉素的硫酸钙、磷酸钙治疗慢性骨髓炎效果满意;而吸附万古霉素的同种异体骨治疗慢性骨髓炎感染率较高,可能因万古霉素释放过快,感染灶内难以维持较长时间的抗生素有效浓度所致.磷酸钙万古霉素组能够在控制感染的同时促进新骨生成而修复缺损区.

Objective To explore the curative effects of antifungal drug combined with surgical treatment on disseminated cryptococcosis with the main focuses in skin soft tissues and lungs.Methods A retrospective analysis was made in the diagnosis and treatment results of 3 cases of disseminated cryptococcosis with the skin soft tissues and lung as the target organs.Results The first symptom of the 3 patients was the ulceration of skin soft tissue,and 2 cases had paraplegia with the focuses all in the sacroiliac.One case suffered from rheumatoid arthritis and took low dose of glucocorticoid for 13 years,and one month ago,a large area of ulcer occurred in the posterior part of front left thigh.This patient had no symptom of cryptococcal meningitis.The lung image was positive,and the examination result of cerebrospinal fluid was negative.All the 3 patients received the surgical treatment combined with antifungal drug.Tow cases were cured,while one did not.Conclusion Disseminated cryptococcosis with skin soft tissue and lung as the main target organs can easily be misdiagnosed as general bacterial infection,which may result in the poor curative effect in the longterm hospitalization.The final diagnosis needs the support of pathology and etiology.The antifungal treatment combined with surgery is a valuable choice of treatment.