目的 探讨载万古霉素硫酸钙复合骨形态发生蛋白2(BMP-2)治疗创伤性骨髓炎的临床效果.方法 回顾性分析2013年1月至2015年12月南京军区南京总医院收治的59例创伤性骨髓炎患者的临床资料,男27例,女32例;年龄21~62岁,平均年龄37.6岁;骨髓炎按Cierny-Mader分类:Ⅲ型37例、Ⅳ型22例;一期行内固定治疗39例、外固定支架固定20例.彻底清创后病灶内植入载万古霉素硫酸钙复合BMP-2,所有患者均改用外固定支架固定骨折断端,其中17例软组织缺损或骨缺损较大者采用带蒂转移皮瓣覆盖创面或肌筋膜瓣填塞髓腔.结果 所有患者均获随访,平均随访时间13.4个月(12~23个月).创面愈合良好,无窦道、软组织缺损及骨外露;骨折均获愈合,无感染复发,骨愈合时间5~14个月(平均7.8个月).3例患者因骨缺损范围较大而致骨折延迟愈合,二期植入自体髂骨后骨折愈合.末次随访时按Johner-Wruhs评分标准评定疗效:优54例、良5例,优良率100%;所有患者均可负重行走,无明显疼痛及畸形.结论 载万古霉素硫酸钙与BMP-2复合植入模式治疗创伤性骨髓炎,成骨可靠,安全性高,抗感染效果满意.

Objective To observe the clinical effect of extract from rabbit skin inflamed by vaccinia virus (ERSIVV) in the limb salvage treatment of diabetic foot (DF).Methods From January 2013 to June 2015,46 DF patients with infection who needed limb salvage treatment in our hospital were selected and divided into the observation group and the control group according to treatment program,23 cases in each group.All of patients were graded according to the Wagner and accepted surgical treatment.Then observation group received the ERSIVV,the control group was given mecobalamin injection.The clinical efficacy and complications of the two groups were compared.Results The VAS scores of the two groups decreased after treatment,and the VAS scores 2 weeks and 3 weeks after treatment in the observation group were lower than those of the control group,the total effective rates of the pain improvement in the observation group were 82.61％ and 86.96％,which were higher than those in the control group (69.57％ and 73.91％) (P ＜ 0.05).The scores of neurological symptoms and signs of the two groups decreased after treatment,and the scores in the observation group were lower than those in the control group,the difference was statistically significant (P ＜ 0.05).After treatment,the nerve conduction velocity in the two groups all increased,and the change of the observation group was more obvious (P ＜ 0.05).There were no obvious complication and adverse reaction in the two groups during the treatment period.Conclusion The ERSIVV can effectively improve the pain,neurologic symptoms and signs of the patients with DF infection after the limb salvage treatment,promote the recovery of nerve conduction speed,it has good clinical efficacy and safety.

1病例摘要 1.1病例1 1.1.1病史患者男性,42岁,"反复腹泻2年,发现血压升高及肾功能不全10天",于2003-01-26入院.

1病情摘要 1.1病史患者女性,44岁,因"狼疮性肾炎维持性腹膜透析3月余,少尿、气促伴水肿2周"入院.患者于1995年初无诱因出现尿中泡沫增多伴面部及双下肢水肿,曾以"慢性肾炎"服用激素、雷公藤等治疗,因疗效不佳1997年入本院.入院查:尿蛋白2.86 g/24h,尿RBC 285万/ml,多形性.Hb 90g/L,血ALB 22g/L,SCr 92μmol/L,抗核抗体(ANA)、A-dsDNA、抗Sm抗体均阴性,补体正常.