En bloc切除结合膜诱导技术分期治疗长骨Cierny-MaderⅣ型创伤后骨感染  

En bloc resection combined with induced membrane technique for treatment of Cierny-Mader type Ⅳ posttraumatic long bone infection

作　　者：吴宏日[1] 贾硕[2] 傅景曙 喻胜鹏 余鑫[1] 沈杰[1] 谢肇[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆400038 [2]中南大学湘雅二医院眼科

出　　处：《中华创伤杂志》2017年第2期147-152,共6页Chinese Journal of Trauma

基　　金：总后勤部卫生部重点项目（BWS13C014）;国家自然科学基金面上项目（81672160）

摘　　要：目的探讨en bloc切除结合膜诱导技术对长骨Cierny—MaderⅣ型创伤后骨感染的治疗效果。方法采用回顾性病例系列研究分析2013年1月-2015年1月收治的36例长骨创伤后骨感染患者，其中男30例，女6例；年龄21-68岁，平均41岁。Cierny—Mader分型均为Ⅳ型。均采用en bloc切除清除病灶及膜诱导骨重建技术分期治疗。观察患者感染治愈、骨愈合、肢体功能活动及并发症情况。结果36例患者Ⅰ期清创后形成2—10．9cm（平均5．5cm）的节段性骨缺损。7例需行局部皮瓣转移覆盖伤口。5例行二次清创。全身使用抗生素及Ⅱ期植骨时间分别为2—6周（平均2．5周）和6-36周（平均12周）。随访24-45个月，平均29．5个月。1例复发，予再次清创及永久抗生素骨水泥填充后痊愈。骨感染治愈率为97％（35／36）。所有患者于术后4—8个月（平均5．9个月）获得骨愈合，并最终能独立行走。30例恢复原本工作或体力劳动。患者无疼痛及再骨折等并发症，6例出现邻近关节僵硬。结论采用en bloc切除结合膜诱导技术能够彻底清除病灶，降低复发率并保存患肢功能，是根治性保肢治疗长骨Cierny—MaderⅣ型创伤后骨感染简单、有效的新方法。Objective To investigate the results of Cierny-Mader type IV posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique. Methods A retrospective case series analysis was made on 36 patients with posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique from January 2013 to January 2015. There were 30 male and 6 female patients between 21 and 68 years （mean, 41 years）. Infection control, bone union, function activity and complications were detected after operation. Results After debridement in the first stage, a segmental bone defect of 5.5 cm in length （range, 2-10.9 cm） was seen in all patients. Seven patients needed a local flap transfer to cover the wound and five patients had a second debridement. Mean duration of systemic antibiotic use was 2 weeks （ range, 1-6 weeks） and mean time interval of second-stage bone grafting was 12 weeks after debridement （range, 6-36 weeks）. Mean follow-up was 29.5 months （range, 24-45 months）. One patient had recurrence and was cured with radical debridement and a permanent acrylic spacers insertion, with the cure rate of bone infection of 97% （35/ 36）. All patients achieved bone union with a mean duration of 5.9 months （ range, 4-8 months）, and were able to walk independently. Thirty patients returned to work or pre-operative physical labor. No pain and re-fracture occurred. Six patients had adjacent joint stiffness. Conclusion En bloc resection combined with induced membrane technique is associated with radical debridement, decreased recurrence rate and limb salvage, indicating a simple and effective method for Cierny-Mader type IV posttraumatic long bone infection.

关 键 词：骨髓炎 骨折 膜诱导技术 

分 类 号：R687.3[医药卫生—骨科学]