抗生素涂层髓内钉结合膜诱导技术治疗髓内钉术后感染性骨不连临床疗效  

The effect of antibiotic coated intramedullary nail combined with induced membrane technique for treatment of infectious bone defects

作　　者：解冰[1] 田竞[1] 刘欣伟[1] 马骏雄[1] 马鑫[1] 周大鹏[1] 项良碧[1] 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2017年第5期271-274,共4页Trauma and Critical Care Medicine

基　　金：全军重大课题项目(AWS14C003)

摘　　要：目的探讨抗生素涂层髓内钉结合膜诱导技术治疗髓内钉术后感染性骨不连的临床疗效。方法回顾性分析沈阳军区总医院自2008年1月至2014年1月收治的24例髓内钉术后发生感染性骨不连患者的临床资料。其中,胫骨14例,股骨10例。清创后骨缺损长度为2.4~6.3 cm,平均3.2 cm。所有患者采用膜诱导技术分两个阶段治疗,第一阶段清创后采用抗生素涂层髓内钉及骨水泥分别占位髓腔及骨缺损,第二阶段采用自体颗粒骨填充骨缺损。记录患肢术后并发症、骨愈合时间及功能情况。结果本组24例患者,术后随访36~108个月,平均67.3个月。术后2例出现皮瓣边缘部分坏死,1例髂骨切口浅表感染,余者无明显围术期并发症发生。23例获得Ⅰ期骨愈合,平均愈合时间7.3个月(6~10个月),完全负重时间5.2个月(4~8个月);1例随访期间出现植骨处骨吸收,再次接受植骨手术后达到完全骨愈合。结论抗生素涂层髓内钉能够在骨缺损部位通过局部释放持续、有效的抗生素来控制感染,同时维持肢体长度和稳定性,结合膜诱导技术可以有效解决感染性骨不连清创后大段骨缺损问题,术后并发症少,患肢功能恢复良好,临床疗效满意。Objective To investigate the clinical efficacy of antibiotic coated intramedullary nail combined with induced membrane technique for reconstruction of infectious bone defects. Methods A retrospective study was performed on 24 cases of patients with infectious bone defects who were admitted from January 2008 to January 2014. According to the lesion site,there were 14 cases of tibia and 10 cases of femur. The length of bone defects ranged 2. 4 to 6. 3 cm,average 3. 2 cm.All patients were treated with two-stage induced membrane technique. In the first stage,the intramedullary nailing and bone cement were filled in medullary cavity and bone defects,autologous granular bone was filled in bone defects in the second stage. The clinical complications,time of bone healing and limbs function were recorded. Results The 24 patients were followed up for an average time of 67. 3 months( ranged 36 to 108 months). Two patients had postoperative flap edge necrosis,1 patient had superficial iliac incision infection,no obvious complications were recorded during perioperative period. The23 patients attained union in a mean time of 7. 3 months( ranged 6 to 10 months) in first stage. The average time of fully weight-bearing was 5. 2 months( ranged 4 to 8 months) postoperatively; one patient suffered bone resorption during followup,and finally achieved complete bone healing after second bone graft surgery. Conclusion For infectious bone defects,the antibiotic coated intramedullary nail combined with induced membrane technique can control local infection by sustainable local release of effective antibiotics of high concentrations while it maintains limb length and stability of fracture ends,provides satisfactory results with minimal complications and good recovery of limbs function.

关 键 词：骨髓炎 创伤 骨缺损 膜诱导技术 骨折内固定术 

分 类 号：R683[医药卫生—骨科学]