开放性骨水泥技术治疗感染性骨及软组织复合缺损的疗效分析  

Therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect

作　　者：周敏[1] 简超[1] 李宗焕[1] 肖卫东[1] 漆白文[1] ZHOU Min;JIAN Chao;LI Zonghuan;XIAO Weidong;QI Baiwen(Orthopaedics,Trauma and Microsurgery Department,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430071

出　　处：《中华显微外科杂志》2022年第2期121-127,共7页Chinese Journal of Microsurgery

基　　金：湖北省自然科学基金(2020CFB662)。

摘　　要：目的通过与常规骨水泥治疗比较,评估开放性骨水泥治疗感染性骨及软组织缺损的临床疗效。方法回顾性分析从2016年1月至2020年1月收治的27例感染性骨及软组织缺损患者,其中一期应用骨水泥外置充填骨缺损、二期行皮瓣覆盖并植骨12例,为开放性骨水泥组;一期行骨水泥充填骨缺损结合皮瓣覆盖、二期行植骨15例,为常规骨水泥组。术后定期换药。门诊复查随访创面情况,行X线检查,比较两组患者的软组织及骨感染控制率、骨缺损愈合时间、皮瓣成活情况及并发症。本研究采用独立样本t检验进行统计分析,P<0.05为差异有统计学意义。结果所有患者均获得9~24(16.5±3.9)个月随访。所有病例骨缺损均愈合,其中开放性骨水泥组骨缺损治疗时间25~34(28.5±2.8)周;骨水泥组骨缺损治疗时间25~36(29.4±3.4)周,差异无统计学意义(P>0.05)。两组各出现2例植入骨水泥后感染未能控制,经过再次清创、冲洗等治疗后感染控制。两组患者所有皮瓣均成活;开放性骨水泥组出现皮瓣裂开3例,积血(液)2例,部分坏死1例;骨水泥组出现伤口裂开4例,积血(液)8例,部分坏死3例;两组皮瓣并发症差异无统计学意义(P>0.05)。骨缺损愈合情况采用Samantha X线评价标准进行评分,两组评分分别为(5.41±0.67)分和(5.40±0.63)分,差异无统计学意义(P>0.05)。Paley骨缺损愈合分级均为优;关节功能评价,开放性骨水泥组:优6例,良3例,可2例,差1例;常规骨水泥组:优6例,良5例,可3例,差1例;差异无统计学意义(P>0.05)。结论与常规骨水泥治疗相比,开放性骨水泥治疗感染性骨缺损,不增加骨及软组织感染机率,且不增加皮瓣并发症发生率,适用于感染的骨及软组织复合缺损患者。Objective To evaluate the therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect by comparison with routine bone cement therapy.Methods A retrospective analysis was carried out in 27 patients who had been treated from January 2016 to January 2020.Of the 27 patients,12 were treated by exposed bone cement filling for bone defect at the first stage,followed by flap and bone grafting at the second stage.Other 15 patients were treated by routine bone cement filling and flap repair at the first stage,followed by bone grafting at the second stage.Regular dressing change was carried out after surgery.All patients entered follow-up by out-patient review for wound condition and X-ray.Infection rate of bone and soft tissue,time of bone union,flap survive rate and complication were compared between the 2 groups.Results The follow-up lased for 9-24(16.5±3.9)months.The bone defects were all healed.The treatment time of bone defects in the group of exposed bone cement was 25-34(28.5±2.8)weeks.The treatment time of bone defect in the routine cement group was 25-36(29.6±3.4)weeks.There was no statistical difference between the 2 groups(P<0.05).Two cases in each group had failed in infection control after bone cement implantation.With further debridement,cleaning and other treatment,the infection was under control.All flaps in the 2 groups survived.In the group of exposed bone cement,there were 3 flaps splitting,2 hemorrhage(effusion)and 1 partial flap necrosis,In the routine bone cement group,there were 4 wound dehiscence,8 hemorrhage(effusion)and 3 partial flaps necrosis.There was no significant difference in flap complications between the 2 groups(P>0.05).The healing of bone defect was evaluated by Samantha X-ray score,the scores of the 2 groups were 5.41±0.67 and 5.40±0.63,respectively,with no statistical significance.The Paley's approach was used to grade the bone healing and the function of adjacent joints.Paley bone defect healing evaluation results weve all excellent.Joint fun

关 键 词：骨水泥技术 骨缺损 软组织缺损 植骨术 外科皮瓣 感染 

分 类 号：R687.3[医药卫生—骨科学]