摘要
目的 :探讨抗生素骨水泥联合外固定支架在下肢开放性骨折伴骨缺损中早期应用的临床疗效。方法 :2013年12月至2015年1月,采用万古霉素抗生素骨水泥联合外固定支架对36例下肢开放性粉碎性骨折伴骨缺损患者进行治疗,男26例,女10例;年龄19~65岁,平均38岁。所选病例均为下肢开放性粉碎性骨折伴骨缺损,不同程度软组织损伤。其中,25例为胫骨骨折,11例股骨骨折。X线提示骨缺损,骨缺损范围为3.0~6.1 cm,平均4.0 cm。按开放性骨折Gustilo分型:ⅢA型24例,ⅢB型12例。观察创口感染率、植骨时间、骨折愈合时间及术后下肢功能。骨折临床愈合后1个月患肢功能参照Paley标准进行功能评价。结果:36例患者获得随访,时间3~24个月,平均(6.0±3.0)个月,术后创面愈合良好,未发现骨感染及骨缺损不愈合等情况。患者使用抗生素骨水泥早期治疗后再次手术植骨时间为6周,部分延后到8周,到骨折基本愈合,疗程为4~8个月,平均(5.5±1.5)个月。根据Paley等骨与功能分级评价功能,优25例,良8例,可3例。结论:抗生素骨水泥联合外固定支架是治疗下肢开放性骨折骨缺损早期处理的有效方法。该方法操作简单、手术时间短、绝对优势控制感染、提供良好的植骨床,利用膜诱导技术植骨,获得良好的骨愈合。
Objective：To discuss the curative effect of the early application of the antibiotic laden bone cement（ALBC）combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect. Methods：From December 2013 to January 2015,36 cases of lower limb open comminuted fractures complicated with bone defects were treated by the vancomycin ALBC combined with the external fixation support,including 26 males and 10 females with an average age of 38.0 years old ranging from 19 to 65 years old. The included cases were all open fractures of lower limbs complicated with bone defects with different degree of soft tissue injuries. Among them,25 cases were tibial fractures,11 cases were femoral fractures. The radiographs indicated a presence of bone defects,which ranged from 3.0 to 6.1 cm with an average of4.0 cm. The Gustilo classification of open fractures ：24 cases were type ⅢA,12 cases were typr ⅢB. The percentage of wound infection,bone grafting time,fracture healing time and postoperative joint function of lower limb were observed. The function of injured limbs was evaluated at 1 month after the clinical healing of fracture based on Paley evaluation criterion. Results：All cases were followed up for 3 to 24 months with an average of（6.0±3.0） months. The wound surface was healed well,neither bone infections nor unhealed bone defects were presented. The reoperation of bone grafting was done at 6 weeks after the patients received an early treatment with ALBC,some of them were postponed to 8 weeks till the approximate healing of fractures,the treatment course lasted for 4 to 8 months with an average of（5.5±1.5） months. According to Paley and other grading evaluations of bone and function,there were 27 cases as excellent,5 cases as good,3 cases as ordinary. Conclusion：The ALBC combined with external fixation support was an effective method for early treatment to treat the traumatic lower limb open fractures complicated with bone defects. This method was typ
出处
《中国骨伤》
CAS
2017年第3期270-273,共4页
China Journal of Orthopaedics and Traumatology
关键词
抗生素骨水泥
骨折
开放性
骨缺损
外固定器
Antibiotic laden bone cement（ALBC）
Fractures
open
Bone defect
External fixators
