摘要
目的探讨扩髓灌洗并更换成含抗生素骨水泥涂层髓内钉内固定治疗胫骨骨折髓内钉内固定术后感染的临床疗效。方法回顾性分析自2012-06—2018-12诊治的10例胫骨骨折髓内钉内固定术后感染,术中扩大髓腔进行髓腔灌洗、彻底清创,然后更换成含抗生素骨水泥涂层髓内钉一期内固定胫骨骨折。3例经窦道清创切除感染骨后用抗生素骨水泥填充骨缺损,8周后取出骨水泥并行自体松质骨颗粒植骨。结果 10例术后均获得随访,随访时间平均28(12~48)个月。所有患者术后感染均未复发,未再次骨折。7例无骨缺损者胫骨骨折愈合时间平均5(4.0~5.5)个月。3例骨缺损取自体髂骨植骨者骨折愈合时间分别为4、5、6个月,平均5个月。3例术后1年内出现髌前疼痛,经康复治疗后痊愈。结论扩髓灌洗并更换成含抗生素骨水泥涂层髓内钉内固定是胫骨骨折髓内钉内固定术后感染的有效治疗方法,治疗周期短,感染治愈率高,同时还有利于骨折愈合。
ObjectiveTo investigate the clinical effect of reaming and lavage and replacement of antibiotic bone cement coated intramedullary nail internal fixation in the treatment of tibial fracture infection after intramedullary nail internal fixation.MethodsA retrospective analysis of 10 cases of tibial fractures with infection after intramedullary nail internal fixation treated from June 2012 to December 2018 was performed.During the operation,the medullary cavity was expanded,and lavaged,and the wound was thoroughly debrided,and then the antibiotic bone cement coating intramedullary nail internal fixation was replaced.The fracture was fixed by nailing within one period.In 3 cases,the infected bone was removed via sinus debridement and the bone defect was filled with antibiotic bone cement.After 8 weeks,the bone cement was removed and autologous cancellous bone particles were grafted.ResultsAll 10 cases were followed up with an average follow-up time of 28(12-48)months.All patients had no recurrence of infection and no fracture again.The average healing time of tibial fractures in 7 cases without bone defect was 5(4.0-5.5)months.The fracture healing time of 3 cases of bone defect with autogenous iliac bone grafting was 4,5,and 6 months,with an average of 5 months.Three patients developed prepatellar pain within 1 year after surgery,and were cured after rehabilitation and physical therapy.ConclusionReaming lavage and replacing the antibiotic bone cement coating intramedullary nail internal fixation is an effective treatment for infection after tibial fracture treated with intramedullary nail internal fixation,with short treatment cycle,high infection cure rate,and it is conducive to fracture healing.
作者
刘重
郭永明
马宁
张朝
滕云升
吴珂
LIU Zhong;GUO Yong-ming;MA Ning;ZHANG Zhao;TENG Yun-sheng;WU Ke(Department of Orthopaedic Trauma,Xi'an 521 Hospital,Xi'an,Shaanxi 710065,China)
出处
《中国骨与关节损伤杂志》
2021年第2期139-142,共4页
Chinese Journal of Bone and Joint Injury
关键词
胫骨骨折
交锁髓内钉
内固定
感染
扩髓
灌洗
抗生素骨水泥
Tibia fracture
Interlocking intramedullary nail
Internal fixation
Infection
Reaming
Lavage
Antibiotic bone cement
