摘要
目的探讨膜诱导技术结合内固定分期治疗股骨感染性骨不连的临床疗效。方法采用回顾性病例系列研究分析2016年1月至2018年12月解放军联勤保障部队第九二〇医院收治的21例股骨感染性骨不连患者的临床资料,其中男13例,女8例;年龄18〜57岁[(38.9±6.7)岁]。病程7〜78个月[(27.1±11.4)个月]。均采用膜诱导技术分两期进行手术:Ⅰ期去除原固定物并彻底清创,清创后骨缺损长度5〜15 cm[(7.4±1.9)cm],放置抗生素骨水泥,锁定加压钢板(LCP)固定;Ⅱ期去除抗生素骨水泥,植骨重建骨缺损,采用髓内钉和(或)LCP固定断端。评估Ⅰ期和末次随访时感染控制[包括患肢伤口情况及白细胞计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)]及并发症发生情况;记录骨缺损愈合时间;末次随访时根据Paley感染性骨缺损骨愈合评分标准评价骨愈合情况,通过膝关节活动度评价患肢功能恢复情况。结果患者均获随访23〜43个月[(31.9±6.7)个月]。Ⅰ期术后4例出现感染复发,予以重复清创后伤口愈合。Ⅱ期术后末次随访伤口无感染表现,白细胞计数[(6.1±1.8)×10^(9)/L]、CRP[(10.1±3.1)mg/L]及ESR[(10.2±3.4)mm/h]较术前[分别为(15.0±4.8)×10^(9)/L、(69.8±14.8)mg/L、(66.2±13.2)mm/h]显著降低(P<0.05)。并发症发生率为43%,除4例I期术后感染复发外,3例髂后上棘处取骨处伤口感染,经换药后愈合;2例肢体短缩,分别为4 cm和3 cm。患者均获骨性愈合,愈合时间为6〜16个月[(8.8±2.7)个月]。末次随访时Paley感染性骨缺损骨愈合评分标准:优19例,良2例;膝关节屈曲活动度为90.0°(61.5°,120.0°),较术前的30.0°(15.0°,110.0°)显著提高(P<0.05)。结论膜诱导技术结合内固定分期治疗股骨感染性骨不连可有效控制感染,实现骨愈合,减少并发症的发生,促进患肢功能恢复。
Objective To investigate the clinical effect of induced menilDrane technique combined with staged internal fixation for treatment of infected femoral nonunion.Methods A retrospective case series study was conducted to analyze the clinical data of 21 patients with infected femoral nonunion treated from January 2016 to December 2018 in 920th Hospital of Joint Logistics Support Force of PLA.There were 13 males and 8 females,with the age of 18-57 years[(38.9±6.7)years].The duration of nonunion was 7-78 months[(27.1±11.4)months].All patients were treated by induced membrane technique in two stages.At stage Ⅰ,the original internal fixation was removed and debrided thoroughly,then the antibiotic-loaded bone cement and locking compression plate(LCP)were placed.The length of bone defect following debridement was 5-15 cni[(7.4±1.9)cm].At stage Ⅱ,the hone defect was reconstructed with hone grafts and fixed with the intramedullary nail and/or LCP.The wound condition,white blood cell count,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were recorded after stage Ⅰ surgeiy and at the last follow-up to measure infection control.The complications and hone healing time were recorded.The bone healing was evaluated by the Paley criteria and the functional recovery of the affected limb was evaluated by the range of motion of the knee at the last follow-up.Results All patients were followed up for 23~43 months[(31.9±6.7)months].The infection recurred in 4 patients after stage Ⅰ surgery,and the wound healed after repealed debridement.There was no infection rerunence after stage Ⅱ surgery.The white blood cell count,CRP and ESK were(6.1±1.8)× 1O^(9)/L,(10.1±3.1)mg/L,(10.2±3.4)mm/h at the last follow-up,significantly decreased frompreopemtive(15.0±4.8)×1O^(9)/L,(69.8±14.8)mg/L,(66.2±13.2)mm/h(P<0.05).The incidence of complications was 43%.Besides infection recurrence in 4 patients after stage Ⅰ surger Ⅱ the donor site at the posterior superior iliac spine in 3 patients showed delayed healing,and th
作者
石健
杨晓勇
陈星宇
张曦娇
何晓清
陈黔
周智
岳正华
徐永清
Shi Jian;Yang Xiaoyong;Chen Xingyu;Zhang Xijiao;He Xiaoqing;Chen Qian;Zhou Zhi;Yue Zhenghua;Xu Yongqing(Department of Orthopedic Surgery,920th Hospital of Joint Logistic Support Force of PLA,Kunming 650032,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第6期555-561,共7页
Chinese Journal of Trauma
基金
云南省创伤骨科临床医学中心项目(ZX20191001)
解放军联勤保障部队第九二〇医院科技计划发展项目(2019YGB07)。
关键词
股骨骨折
骨折
不愈合
内固定器
骨髓炎
膜诱导技术
Femoral fractures
Fractures,ununited
Internal fixators
Osteomyelitis
Induced membrane technique
