Abstract：
OBJECTIVE: To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot.
METHODS: From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated.
RESULTS: Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients.
CONCLUSIONS: Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.
METHODS: From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated.
RESULTS: Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients.
CONCLUSIONS: Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.
摘要：
目的：探讨万古霉素硫酸钙联合内固定治疗糖尿病足跟骨骨髓炎继发跟骨喙样骨折的临床疗效。
方法：2018年4月至2021年10月，对5例糖尿病足继发跟骨骨髓炎患者进行回顾性分析。包括2名男性和3名女性，年龄48～60岁；糖尿病病程5～13年；糖尿病足病程18～52天；5例按Wagner分级为Ⅲ级。所有患者均接受清创治疗，万古霉素骨水泥植入,Ⅰ期负压抽吸,万古霉素硫酸钙和Ⅱ期内固定治疗跟骨喙样骨折。记录手术切口及骨折愈合时间,观察骨髓炎的复发。对术后12个月的美国骨科足踝协会(AOFAS)评分及渗出情况进行评价。
结果：5例患者均顺利完成手术，无下肢血管阻塞，随访16~36个月。内固定术后创面愈合时间为16～26天,骨折愈合时间16～27周。术后12个月AOFAS评分65～91分,2名患者获得了优异的效果，2个好，1个公平。其中,1例术后5个月因烫伤引起足背部皮肤溃疡（无并发症），经治疗后痊愈;2例患者发生伤口渗漏并发症,并在换药后恢复。所有患者均未发生骨髓炎或骨折。
结论：万古霉素硫酸钙内固定治疗糖尿病足继发跟骨骨髓炎不仅能控制感染，还能促进骨折愈合，取得了良好的临床效果。
方法：2018年4月至2021年10月，对5例糖尿病足继发跟骨骨髓炎患者进行回顾性分析。包括2名男性和3名女性，年龄48～60岁；糖尿病病程5～13年；糖尿病足病程18～52天；5例按Wagner分级为Ⅲ级。所有患者均接受清创治疗，万古霉素骨水泥植入,Ⅰ期负压抽吸,万古霉素硫酸钙和Ⅱ期内固定治疗跟骨喙样骨折。记录手术切口及骨折愈合时间,观察骨髓炎的复发。对术后12个月的美国骨科足踝协会(AOFAS)评分及渗出情况进行评价。
结果：5例患者均顺利完成手术，无下肢血管阻塞，随访16~36个月。内固定术后创面愈合时间为16～26天,骨折愈合时间16～27周。术后12个月AOFAS评分65～91分,2名患者获得了优异的效果，2个好，1个公平。其中,1例术后5个月因烫伤引起足背部皮肤溃疡（无并发症），经治疗后痊愈;2例患者发生伤口渗漏并发症,并在换药后恢复。所有患者均未发生骨髓炎或骨折。
结论：万古霉素硫酸钙内固定治疗糖尿病足继发跟骨骨髓炎不仅能控制感染，还能促进骨折愈合，取得了良好的临床效果。
