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Abstract：
OBJECTIVE: To compare antibiotic-impregnated bone cement coverage (bone cement surface technique; BCS-T) versus vacuum sealing drainage (VSD) for tibial fracture with infected bone and soft tissue defect.
METHODS: This retrospective analysis compared the clinical outcomes in patients undergoing BCS-T (n = 16) versus VSD (n = 15) for tibial fracture with infected bone and soft tissue defect at the Third Hospital of Hebei Medical University from March 2014 to August 2019. For BCS-T group, osseous cavity was filled with autograft bone graft after debridement, and then the wound was covered with a 3-mm layer of bone cement impregnated with vancomycin and gentamycin. The dressing was changed every day in the first week, and every 2 ~ 3 days in the second week. For VSD group, a negative pressure of -150 ~ -350 mmHg was maintained, and the dressing was changed every 5-7 days. All patients received antibiotics treatment based on bacterial culture results for 2 weeks.
RESULTS: The 2 groups did not differ in age, sex and key baseline characteristics, including type of Gustilo-Anderson classification, size of the bone and soft tissue defect, the percentage of primary debridement, bone transport, and the time from injury to bone grafting. The median follow-up was 18.9 months (range:12-40). The time to complete coverage of bone graft by granulation tissue was 21.2 (15.0-44.0) and 20.3 (15.0-24.0) days in the BCS-T and VSD groups, respectively (p = 0.412). The 2 groups also did not differ in wound healing time (3.3 (1.5-5.5) versus 3.2(1.5-6.5) months; p = 0.229) and bone defect healing time (5.4(3.0-9.6) versus 5.9(3.2-11.5) months; p = 0.402). However, the cost of covering material was significantly reduced in the BCS-T group (2071 ± 134 versus 5542 ± 905 yuan; p = 0.026). Paley functional classification at 12 months did not differ between the 2 groups (excellent in 87.5% versus 93.3% in the 2 groups; p = 0.306).
CONCLUSIONS: BCS-T could achieve clinical outcomes similar to VSD in patients receiving bone graft for tibial fracture with infected bone and soft tissue defect, but material cost was significantly reduced. Randomized controlled trials are needed to verify our finding.
METHODS: This retrospective analysis compared the clinical outcomes in patients undergoing BCS-T (n = 16) versus VSD (n = 15) for tibial fracture with infected bone and soft tissue defect at the Third Hospital of Hebei Medical University from March 2014 to August 2019. For BCS-T group, osseous cavity was filled with autograft bone graft after debridement, and then the wound was covered with a 3-mm layer of bone cement impregnated with vancomycin and gentamycin. The dressing was changed every day in the first week, and every 2 ~ 3 days in the second week. For VSD group, a negative pressure of -150 ~ -350 mmHg was maintained, and the dressing was changed every 5-7 days. All patients received antibiotics treatment based on bacterial culture results for 2 weeks.
RESULTS: The 2 groups did not differ in age, sex and key baseline characteristics, including type of Gustilo-Anderson classification, size of the bone and soft tissue defect, the percentage of primary debridement, bone transport, and the time from injury to bone grafting. The median follow-up was 18.9 months (range:12-40). The time to complete coverage of bone graft by granulation tissue was 21.2 (15.0-44.0) and 20.3 (15.0-24.0) days in the BCS-T and VSD groups, respectively (p = 0.412). The 2 groups also did not differ in wound healing time (3.3 (1.5-5.5) versus 3.2(1.5-6.5) months; p = 0.229) and bone defect healing time (5.4(3.0-9.6) versus 5.9(3.2-11.5) months; p = 0.402). However, the cost of covering material was significantly reduced in the BCS-T group (2071 ± 134 versus 5542 ± 905 yuan; p = 0.026). Paley functional classification at 12 months did not differ between the 2 groups (excellent in 87.5% versus 93.3% in the 2 groups; p = 0.306).
CONCLUSIONS: BCS-T could achieve clinical outcomes similar to VSD in patients receiving bone graft for tibial fracture with infected bone and soft tissue defect, but material cost was significantly reduced. Randomized controlled trials are needed to verify our finding.
摘要：
目的：比较抗生素浸渍骨水泥覆盖率（骨水泥表面技术；BCS-T）与负压封闭引流（VSD）治疗胫骨骨折伴感染性骨和软组织缺损。
方法：回顾性分析比较2014年3月至2019年8月在河北医科大学第三医院接受BCS-T（n=16）和VSD（n=15）治疗胫骨骨折伴感染骨和软组织缺损患者的临床结果。对于BCS-T组，清创术后用自体植骨填充骨腔，然后用充满万古霉素和庆大霉素的3毫米骨水泥覆盖伤口。第一周每天都换敷料,第二周每2~3天。对于VSD组，维持-150~-350mmHg的负压，每隔5-7天更换一次敷料。所有患者均根据细菌培养结果接受抗生素治疗2周。
结果：两组在年龄上没有差异，性别和关键基线特征，包括Gustilo-Anderson的分类类型，骨和软组织缺损的大小，原发性清创术的百分比，骨运输，以及从受伤到植骨的时间。中位随访时间为18.9个月（范围：12-40）。BCS-T组和VSD组肉芽组织覆盖植骨的时间分别为21.2天(15.0-44.0天)和20.3天(15.0-24.0天),分别(p=0.412)。两组的伤口愈合时间（3.3（1.5-5.5）与3.2（1.5-6.5）个月；p=0.229）和骨缺损愈合时间（5.4（3.0-9.6）与5.9（3.2-11.5）个月；p=0.402）也没有差异。然而,BCS-T组的覆盖材料成本明显降低（2071±134比5542±905元；p=0.026）。12个月时的Paley功能分类在两组之间没有差异（两组分别为87.5％和93.3％；p=0.306）。
结论：BCS-T治疗胫骨骨折伴感染性骨和软组织缺损的植骨治疗可达到与VSD相似的临床效果。但材料成本显著降低。需要随机对照试验来验证我们的发现。
方法：回顾性分析比较2014年3月至2019年8月在河北医科大学第三医院接受BCS-T（n=16）和VSD（n=15）治疗胫骨骨折伴感染骨和软组织缺损患者的临床结果。对于BCS-T组，清创术后用自体植骨填充骨腔，然后用充满万古霉素和庆大霉素的3毫米骨水泥覆盖伤口。第一周每天都换敷料,第二周每2~3天。对于VSD组，维持-150~-350mmHg的负压，每隔5-7天更换一次敷料。所有患者均根据细菌培养结果接受抗生素治疗2周。
结果：两组在年龄上没有差异，性别和关键基线特征，包括Gustilo-Anderson的分类类型，骨和软组织缺损的大小，原发性清创术的百分比，骨运输，以及从受伤到植骨的时间。中位随访时间为18.9个月（范围：12-40）。BCS-T组和VSD组肉芽组织覆盖植骨的时间分别为21.2天(15.0-44.0天)和20.3天(15.0-24.0天),分别(p=0.412)。两组的伤口愈合时间（3.3（1.5-5.5）与3.2（1.5-6.5）个月；p=0.229）和骨缺损愈合时间（5.4（3.0-9.6）与5.9（3.2-11.5）个月；p=0.402）也没有差异。然而,BCS-T组的覆盖材料成本明显降低（2071±134比5542±905元；p=0.026）。12个月时的Paley功能分类在两组之间没有差异（两组分别为87.5％和93.3％；p=0.306）。
结论：BCS-T治疗胫骨骨折伴感染性骨和软组织缺损的植骨治疗可达到与VSD相似的临床效果。但材料成本显著降低。需要随机对照试验来验证我们的发现。
