髓内钉结合载抗生素硫酸钙辅助Ilizarov环形外固定架骨搬运治疗胫骨感染性骨缺损  

Tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate for treatment of segmental bone defect

作　　者：许毅博 马腾[1] 王谦[1] 任程[1] 刘德印 李明[1] 杨娜[1] 路遥[1] 孙亮[1] 黄强[1] 戚鸿飞 李忠[1] 张堃[1] Xu Yibo;Ma Teng;Wang Qian;Ren Chen;Liu Deyin;Li Ming;Yang Na;Lu Yao;Sun Liang;Huang Qiang;Qi Hongfei;Li Zhong;Zhang Kun(Department of Orthopedic Trauma,Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属西安市红会医院创伤病院下肢病区,710054

出　　处：《国际外科学杂志》2021年第2期97-102,F0004,共7页International Journal of Surgery

摘　　要：目的分析髓内钉结合载抗生素硫酸钙辅助Ilizarov环形外固定架骨搬运治疗胫骨感染性骨缺损患者的临床效果。方法回顾性分析2018年1月一2020年1月于西安交通大学附属西安市红会医院创伤病院下肢病区治疗并接受手术的11例胫骨骨感染清创后存在骨缺损的患者的临床资料。其中男性7例,女性4例;年龄32-67岁,平均年龄(48.55±14.1)岁;吸烟饮酒患者6例,合并内科基础疾病9例,包括糖尿病、高血压、冠心病等。受伤原因:车祸伤8例,其他3例,包括高处坠落、摔倒、重物砸伤。最初损伤为开放性骨折2例。记录患者的骨缺损长度、术中出血量、并发症情况,随访时监测硫酸钙吸收时间、骨搬运时间,外固定架带架时间及外固定架指数,末次随访采用Paley评分评价骨缺损愈合分级及邻近关节功能。采用SPSS 24.0软件对数据进行统计分析。结果纳入11例患者骨感染均得到控制,未见复发。随访时间平均为23.2个月,骨缺损平均长度为(8.1±1.6)cm.硫酸钙吸收时间平均为(6.6±2.6)个月,骨搬运时间平均为(11.4±2.8)周,外固定架带架时间平均为(4.7±1.2)个月,外固定架指数平均为(0.58±0.07)月/厘米,下地负重时间平均为(6.1±1.4)个月。并发症总体发生率为36.4%。骨愈合方面优良率为90.9%,临近关节功能评分优良率为100%。结论同期髓内钉结合硫酸钙人工骨辅助Ilizarov环形外固定架的骨搬运技术可以减少外固定架的固定时间,有效控制感染,减少并发症发生率、允许患者更早负重及恢复活动,提高患者的生活质量。Objective To analyze the clinical outcomes of tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate for treatment of segmental bone defect.Methods A retrospective analysis was conducted by enrolling 11 surgically treated patients with tibial segmental bone defect after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department,Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University from Jan.2018 to Jan.2020.The collected clinical materials and data included gender,age,injury mechanism,smoke or alcohol,comorbidities,intraoperative bleeding loss,bone defect length,resorption time of calcium sulphate,bone transport time,external fixation time,external fixation index,complications and Paley bone and functional criteria.SPSS 24.0 software was used to analyze the data.Results Eleven patients were followed up for 8 to 31 months(average 23.2 months).All patients achieved bone healing and the infection was eradicated with no sign of recurrence.The mean length of defect was(8.1±1.6)cm,mean resorption time of calcium sulphate was(6.6±2.6)months,bone transport time was(11.4±2.8)weeks,external fixation time was(4.7±1.2)months,external fixation index was(0.58±0.07)month/cni and full weight bearing time was(6.1±1.4)months.The complication rate was 36.4%including deep vein thrombosis,delayed union of the docking site,pin tract infection and sterile draining of the wound.Paley bone evaluation results were excellent and good in 10 patients(90.9%)and functional results were excellent and good in 11 patients(100%).Conclusion Tibial bone transport over an intramedullary nail in combi nation with antibiotic-loaded calcium sulphate is a safe,reliable and successful method for segmental bone defect and eradication of infection which reduces external fixation time and complication rate,allows patients perform weight bearing and return to daily life earlier.

关 键 词：胫骨 感染 硫酸钙 骨缺损 Ilizarov骨搬运 髓内钉 

分 类 号：R687.3[医药卫生—骨科学]