膜诱导技术治疗胫骨创伤后骨髓炎  

Induced membrane technique for treatment of post-traumatic tibial osteomyelitis

作　　者：汪小华[1] 傅景曙 沈杰[1] 谢肇[1] 

机构地区：[1]第三军医大学西南医院骨科、全军矫形外科中心,重庆400038

出　　处：《中华创伤杂志》2015年第4期299-302,共4页Chinese Journal of Trauma

基　　金：国家自然科学基金面上资助项目（30973065）;创伤、烧伤与复合伤国家重点实验室开放基金资助项目（SKLKF201313）;全军后勤科研重点资助项目（BWS13C014）

摘　　要：目的探讨膜诱导技术治疗胫骨创伤后骨髓炎的临床疗效。方法回顾性分析2011年8月-2012年10月收治的17例胫骨创伤后骨髓炎患者，其中男13例，女4例；年龄19．67岁，平均40．9岁。I期清创后平均骨缺损长度6．7cm（2．0—18．5cm），在骨缺损处填塞抗生素骨水泥诱导生物膜形成，Ⅱ期在膜内植骨重建骨缺损，观察膜诱导技术治疗胫骨创伤后骨髓炎的临床疗效。结果17例患者随访24-32个月（平均27个月），均获得临床骨愈合。术后4～6个月均获得影像学骨愈合。其中2例I期术后感染复发，再次清创后，1例发生外固定架近端钉道感染，拆除外固定钢板螺钉并局部换药处理后控制感染；2例出现功能障碍，1例足内翻畸形，1例踝关节僵直，1例出现金属排斥反应。结论膜诱导技术治疗胫骨创伤后骨髓炎可取得良好疗效，尤其在大段骨缺损的修复重建中具有显著的优势。治疗过程中应加强关注患肢功能性并发症的预防。Purpose To investigate the clinical outcome of induced membrane technique for treatment of post-traumatic tibial osteomyelitis. Methods A retrospective analysis was made on 17 ca- ses of post-traumatic tibial osteomyelitis admitted from August 2011 to October 2012. There were 13 males and 4 females aged 19-67 years （mean, 40.9 years）. Mean length of bone defect was 6.7 cm （range, 2.0-18.5 cm）. Surgical treatments were performed including phase I surgical debridement and antibiot- ics-loaded bone cement impregnation to induce a membrane and phase lI bone defect reconstruction by intramembranous bone grafting. Clinical effect of the treatment was evaluated. Results Bone healing was detected at the 27-month follow-up （range, 24-32 months）. Radiographic healing was obtained 4-6 months after operation. Two cases of recurrent infection were noted after phase I surgery and had another debridement. External fixator proximal pin track infection occurred in one case and infection was controlled by hardware removal and dressing change. There was one case of metal rejection, two function disorders, one clubfoot, and one ankle stiffness. Conclusion Induced membrane technique is effec- tive in the treatment of post-traumatic tibial osteomyelitis, especially in lone bone defect reconstruction, but limb functional complications are worth consideration during treatment.

关 键 词：骨髓炎 胫骨骨折 膜诱导技术 

分 类 号：R687.3[医药卫生—骨科学]