抗生素骨水泥被覆锁定钢板在膜诱导技术治疗胫骨创伤后骨感染中的运用  

Application of antibiotic cement-coated locking plates in induced membrane technique for treating post-traumatic tibial osteomyelitis

作　　者：余鑫[1] 贾硕[1] 吴宏日[1] 喻胜鹏 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》2017年第6期539-543,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金面上项目（81672160）;全军后勤科研重点项目（BWS13C014）

摘　　要：目的探讨在膜诱导技术治疗胫骨创伤后骨感染中使用抗生素骨水泥被覆锁定钢板的临床疗效。方法采用回顾性病例系列研究分析2014年9月— 2015年9月运用膜诱导技术治疗的胫骨创伤后骨感染患者71例，其中男55例，女16例；年龄18～60岁，平均37.4岁。清创后骨缺损长度4.0～11 cm，平均4.5 cm。所有患者在Ⅰ期清创术后行抗生素骨水泥被覆锁定钢板作为骨缺损断端的稳定方式；Ⅱ期手术取出锁定钢板，根据骨缺损类型选择髓内钉等内固定，诱导膜内充分植骨。术后动态观察患者C－反应蛋白（CRP）、红细胞沉降率（ESR）、患肢临床表现（红肿热痛及窦道形成）及X线片，评估患者术后感染复发率及植骨愈合情况。结果患者在Ⅱ期术后均获随访13～25个月，平均19.5个月。Ⅰ期术后患肢均无感染复发表现，CRP及ESR均处于正常范围。4例（6%）在Ⅱ期术后患肢出现窦道并接受进一步治疗后感染未再复发。随访期间均获得植骨愈合，愈合时间为4～6个月，平均5.5个月。随访期间均可见植骨逐渐融合、皮质化。结论抗生素骨水泥被覆锁定钢板可以用于膜诱导技术治疗胫骨创伤后骨感染，可缩短骨折愈合时间、降低感染复发率，且对诱导膜的成骨活性无明显影响。Objective To investigate the clinical outcome of post-traumatic tibial osteomyelitis treated by induced membrane technique combined with the antibiotic cement-coated locking plate. Methods A restrospective case series analysis was made on 71 cases of post-traumatic tibial osteomyelitis treated by induced membrane technique from September 2014 to September 2014. There were 55 males and 16 females, aged 18-60 years（mean, 37.4 years）. Mean length of bone defect following debridement was 4.5 cm（range, 4-11 cm）. Antibiotic cement-coated locking plates were used to provide the stability of the bone defects after one-stage debridement. Bone grafting and exchanging the plates with ntramedullary nails were done during the second-stage surgery. Parameters were monitored dynamically after operation to evaluate infection recurrence and bone healing, including C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, clinical features（ sinus formation, redness and swelling, warmth and pain） and X-ray films of the involved limbs. Results All patients were followed up for 13- 25 months （mean, 19. 5 months）. There was no sign of recurring infection and CRP and ESR were normal in all cases after the first stage surgery. However, four cases （6%） had recurrent infection with sinus exudates and their CRP and ESR were abnormal after the second stage surgery, and further treatments were carried out on these patients. Follow-up showed bony union in all patients within mean 5.5 months （range, 4-6 months）. Conclusion Induced membrane technique with antibiotic cementcoated locking plates for treatment of post-traumatic tihial osteomyelitis can shorten bone healing time and decrease infection recurrent rate without obvious impact on osteogenic activity.

关 键 词：骨髓炎 骨折固定术 内 膜诱导技术 

分 类 号：R687.3[医药卫生—骨科学]