三阶段诱导膜技术联合前后入路双钢板固定治疗距骨感染后距骨全缺损的疗效分析  

Three-stage induced membrane technique combined with anterior and posterior double-plate fixation for a total talus defect after infection

作　　者：张宏宁[1] 沈国栋[1] 邹运璇[1] 李雪[1] 杨康勇 赖志斌 赖俊辉 朱永展[1] Zhang Hongning;Shen Guodong;Zou Yunxuan;Li Xue;Yang Kangyong;Lai Zhibin;Lai Junhui;Zhu Yongzhan(Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市中医院骨科,528000

出　　处：《中华创伤骨科杂志》2021年第5期401-408,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨三阶段诱导膜技术联合前后入路双钢板固定治疗距骨感染后全缺损的疗效。方法回顾性分析佛山市中医院骨科2014年1月至2018年12月收治的11例距骨感染患者资料。男8例,女3例;年龄23~63岁,平均37.0岁;4例为距骨开放性全脱位回植感染,3例为GustiloⅢa型距骨开放性骨折内固定术后感染,2例为踝关节GustiloⅢc损伤术后感染,2例合并踝关节内结核。行三阶段序贯治疗,第一阶段手术:清创、全距骨切除、抗生素骨水泥植入,负压封闭引流;7~10 d后行第二阶段手术:更换抗生素骨水泥、再次扩创、创面闭合或皮瓣覆盖;6~12周后行第三阶段手术:感染控制后,采用前后入路双钢板固定Masquelet技术重建。通过比较健侧和患侧的小腿全长评估下肢短缩情况,比较术前与末次随访时AOFAS踝-后足评分和VAS评分以评价功能。结果所有患者术后获12.2~37.5个月(平均24.3个月)随访。术后2例患者皮肤浅表坏死,1例患者腓浅神经损伤。所有患者植骨区矿化良好,踝关节融合。末次随访时,健侧和患侧下肢长度分别为(380.4±35.5)mm和(376.3±32.8)mm,差异无统计学意义(P>0.05)。AOFAS踝-后足评分由术前(28.0±3.4)分提高至末次随访时的(72.8±5.4)分,VAS评分由术前5(5,6)分下降至末次随访时0(0,1)分,差异均有统计学意义(P<0.05)。其中2例患者出现轻度内翻畸形,3例患者术后足踝关节轻度僵硬感。至随访结束,所有患者均未出现感染复发和内固定物断裂。结论三阶段诱导膜技术联合双钢板固定可有效控制距骨感染并能维持和重建距骨全缺损后肢体的长度以及功能。Objective To evaluate three-stage induced membrane technique combined with anterior and posterior double-plate fixation in the treatment of a total talus defect after infection.Methods Included in this study were 11 patients with talus infection who had been treated at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine from January 2014 to December 2018.They were 8 males and 3 females,aged from 23 to 63 years(mean,37.0 years).The infection followed re-implantation after open dislocation of total talus in 4 cases,internal fixation for open talus fracture of Gustilo type Ⅲ a in 3 cases and surgery of open ankle fracture of Gustilo type Ⅲ c in 2 cases,and was complicated with ankle intraarticular tuberculosis in 2 cases.The three-stage operations consisted of debridement,total talus resection,implantation of antibiotic bone cement and vacuum sealing drainage at the first stage,change of bone cement,re-debridement,wound closure or flap covering at the second stage 7 to 10 days later,and reconstruction after infection control using anterior and posterior double-plate fixation and induced membrane technique at the third stage 6 to 12 weeks later.Assessment of lower limb shortening was performed by comparing the full length of the leg between the normal and affected sides;the functions were assessed by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society(AOFAS)and visual analogue scale(VAS)between preoperation and the final follow-up.Results The 11 patients were followed up for an average of 24.3 months(from 12.2 to 37.5 months).Superficial skin necrosis was observed in 2 patients and injury to superficial peroneal nerve in one.Absolute calcification of the autograft area was observed in all patients,leading to ankle fusion.The final follow-ups observed no significant difference in the full length of the leg between the normal and affected sides[(380.4±35.5)mm versus(376.3±32.8)mm](P>0.05),a significant increase in the ankle-hindfoot AOFAS scores from preoperati

关 键 词：距骨 感染 骨板 诱导膜 

分 类 号：R687.3[医药卫生—骨科学]