桥接组合式内固定系统治疗合并感染的股骨骨折  

Bridging compound internal fixation system for treatment of femoral fractures with postoperative infection

作　　者：任义军[1] 严立 胡锐[1] 易新成[1] 程文俊[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院骨修复重建科,武汉430033

出　　处：《中华创伤骨科杂志》2016年第11期956-960,共5页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省卫计委科研项目（WJ2015MB155）

摘　　要：目的探讨桥接组合式内固定系统非接触式固定治疗合并感染的股骨骨折的疗效。方法回顾性分析2011年3月至2014年12月期间收治的17例合并感染的股骨骨折患者资料。男13例，女4例；年龄为16～61岁，平均43．2岁。左侧6例，右侧11例。骨折按AO／OTA分型：32-A2型2例，32-A3型2例；32-B2型3例，32-B3型4例；32-C1型2例，32-C2型3例，32-C3型1例。单臂外固定支架固定11例，组合式外固定支架固定6例。外固定术后至本次手术时间为32-71d，平均41．5d。手术拆除原外固定支架，清除骨折端坏死组织，应用桥接组合式内固定系统非接触式固定骨折。结果17例患者术后获12—24个月（平均17．9个月）随访。所有患者创面均获一期愈合。术后随访实验室检查各项指标（血常规、红细胞沉降率及C反应蛋白）均正常。2例患者因骨质缺损较多二期取髂骨松质骨植骨。术后1年X线片示17例患者股骨均获骨性愈合，随访至内固定物取出时无感染复发。末次随访时采用Kolmert标准评定膝关节功能：优10例，良6例，可1例。结论桥接组合式内固定系统非接触式固定治疗合并感染的股骨骨折疗效良好，感染无复发。Objective To investigate the curative effect of the non-contact bridging compound in- ternal fixation system in the treatment of femoral fractures with postoperative infection. Methods From March 2011 to December 2014, 17 patients with femoral fracture were complicated with postoperative infection. They were 13 males and 4 females, from 16 to 61 years of age （average, 43.2 years）. Six cases were at the left side and 11 at the right side. By AO/OTA classification, there were 2 cases of type 32-A2 and 2 cases of type 32-A3; 3 cases of type 32-B2 and 4 cases of type 32-B3; 2 cases of type 32-C1, 3 cases of type 32-C2 and one of type 32-C3. Unilateral external fixators had been used in 11 cases and compound external fixators in 6 cases. The time between primary fixation and bridging internal fixation ranged from 32 to 71 days （average, 41.5 days）. After removal of original fixation and necrotic tissue at fracture ends, non-contact bridging compound internal fixation system was applied to fix the fracture. Results All the 17 patients received postoperative follow-up for 12 to 24 months （average, 17.9 months）. All the surgical incisions healed by one intention. All the postoperative laboratory indicators were normal, including blood routine examination, blood sedimentation and C-reactive protein. Two patients had to undergo secondary iliac cancellous bone graft due to massive bone defects. X-ray examination one year later revealed bony union in all the 17 cases of femoral fracture. No recurrence of infection was observed before removal of internal fixation. At the final follow-up, the knee joint function by the Kolmert evaluation was excellent in 10 cases, good in 6 cases, and fair in one. Conclusion Non-contact bridging compound internal fixation system can be used in treatment of femoral fractures with postoperative infection to prevent recurrence of infection.

关 键 词：股骨骨折 感染 骨折固定术 内 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]