摘要
目的探讨空心多孔抗生素骨水泥体外成形、体内灌洗的诱导膜技术治疗骨髓炎的效果。方法2010年1月-2014年3月收治14例骨髓炎患者,其中男11例,女3例;年龄18-69岁,平均39.2岁。骨髓炎Cierny-Mader分级：髓内型2例,局限型5例,弥漫型7例。骨髓炎持续时间3个月-20年,平均1.9年。采用一期彻底扩创、空心多孔抗生素骨水泥体外成形后填充体内并结合灌洗,感染控制后二期取出骨水泥植骨的诱导膜技术治疗,二期手术距一期手术时间8-12周,平均10.2周。参照Paley等方法分别评价骨缺损愈合和邻近关节功能恢复情况。结果一期手术仅1例二次扩创,余13例均一次扩创后控制骨感染。二期手术后切口均Ⅰ期愈合。14例均获随访,随访时间15-48个月,平均13.4个月。骨缺损均获临床愈合,愈合时间4-5个月,平均4.4个月。愈合后均恢复负重活动功能,无固定物断裂、感染复发等并发症发生。术后1年骨缺损愈合分级均为优;末次随访时邻近关节功能恢复达优4例、良8例、可2例,优良率85.7%。结论采用空心多孔抗生素骨水泥体外成形、体内灌洗的诱导膜技术治疗骨髓炎,具有抗生素洗提率较高、便于髓腔灌洗、骨水泥取出不会损伤诱导膜和骨水泥-骨界面骨组织等优点,控制骨感染和修复骨缺损效果良好。
Objective To explore the effectiveness of induced membrane technique of hollow porous antibioticimpregnated bone cement forming in vitro and lavage in vivo for the treatment of osteomyelitis. Methods Between January 2010 and March 2014, 14 cases of osteomyelitis were treated by induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo after debridement at the first stage, then the bone cement with bone graft was replaced during the induced membrane after infection was controlled at the second stage. The time from first to second stage operation was 8-12 weeks（average, 10.2 weeks）. There were 11 males and 3 females, aged 18 to 69 years（average, 39.2 years）. According to Cierny-Mader classification of osteomyelitis, 2 cases were rated as intramedullary type, 5 cases as limited type, and 7 cases as diffusing type. The course of osteomyelitis was 3 months to 20 years, averaged 1.9 years. The healing of bone defect and the functionary recovery of adjacent joint were evaluated according to Paley＇s method. Results Debridement was performed for two times in 1 case, and for one time in 13 cases for control of bone infection at the first stage. All incisions healed by first intention after second stage. All patients were followed up 15-48 months（average, 13.4 months）, with no recurrence of infection. All bone defects healed, and the clinical healing time was 4-5 months（average, 4.4 months）. The results of bone healing grade were excellent in all cases at 1 year after operation; the functional recovery of adjacent joint at last follow-up was excellent in 4 cases, good in 8 cases, and fair in 2 cases, and the excellent and good rate was 85.7%. Conclusion Induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo for treatment of osteomyelitis has the advantages of high rate of elution of antibiotics, ease of lavage of medullary cavity, and no damage to induced membrane and bony interface between
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第11期1397-1400,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骨髓炎
诱导膜技术
骨水泥体外成形
灌洗
Osteomyelitis
Induced membrane technique
Bone cement forming in vitro
Lavage
