3D打印模具制备抗生素骨水泥髓内钉治疗下肢长骨感染  

Antibiotic bone cement intramedullary nail prepared using 3D printed mold for the treatment of long bone infection in lower limbs

作　　者：赵伟[1] 冯卫[1] 杨铁翼[1] 任伟 王玉鑫[1] 吕慧成[1] 常志强[1] 冯晓东[1] 王紫横 郭世炳[1] Zhao Wei;Feng Wei;Yang Tieyi;Ren Wei;Wang Yuxin;Lyu Huicheng;Chang Zhiqiang;Feng Xiaodong;Wang Ziheng;Guo Shibing(Department of Orthopedic,Second Affiliated Hospital of Inner Mongolia Medical University,Orthopedic Institute of Inner Mongolia Autonomous Region,Hohhot 010030,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学第二附属医院骨科,内蒙古自治区骨科研究所,内蒙古自治区呼和浩特市010030

出　　处：《中国组织工程研究》2023年第7期1023-1030,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:由于抗生素水泥棒或钉在制备技术、术中操作中存在很多问题,其应用仍然受到限制。目的:探讨应用3D打印模具制备的抗生素骨水泥髓内钉髓腔植入联合扩髓清创治疗下肢长骨骨感染的临床疗效。方法:回顾性分析2018年10月至2020年10月采用3D技术打印模具制作的抗生素骨水泥髓内钉髓腔植入治疗股骨和胫骨感染患者16例,其中股骨10例,胫骨6例。根据Cierny-Mader骨感染分型,Ⅲ型4例,Ⅰ型+Ⅲ型7例,Ⅰ型+Ⅳ型5例。首次(手术)治疗至初始感染时间0.5-120个月,感染持续时间为0.5-118个月。对于髓内钉固定患者,取出髓内钉后对存在感染的骨折端以及交锁螺钉处的软组织瘢痕、肉芽组织和死骨彻底清除,有窦道和软组织脓肿者对感染累及的软组织切除;使用软钻扩髓去除髓腔内坏死及炎性组织,并送检,反复冲洗髓腔后植入抗生素骨水泥髓内钉。对于非髓内钉固定或无固定患者,感染断端或局灶型感染处切开,将窦道和感染的软组织一并切除,按照股骨或胫骨标准髓内钉固定操作步骤开口扩髓,其他过程同前。结果与结论:①患者均随访12-24个月,无一例感染复发和并发症;②1例骨折畸形愈合,1例股骨骨折感染者膝关节活动范围50°;③6例患者在取钉时获得的髓内组织细菌培养和组织学检查均为阴性;④所有患者住院时间7-53个月;医疗费用0.60万-4.94万元;⑤结果表明,应用扩髓清创联合抗生素骨水泥髓内钉髓腔植入是治疗长骨骨感染的有效方法。应用此技术治疗下肢长骨感染可以缩短手术时间,显著降低医疗费用。证据等级:治疗性研究Ⅳ级。BACKGROUND:Due to many problems in the preparation technology and intraoperative operation of antibiotic cement rods or nails,their applications are still limited.OBJECTIVE:To explore the clinical effect of antibiotic bone cement intramedullary nail implantation prepared using 3D printed molds combined with debridement in the treatment of postoperative infection in the lower extremities long bone infection.METHODS:From October 2018 to October 2020,16 patients with femoral and tibial infection were treated by antibiotic bone cement intramedullary nail medullary cavity implantation made of 3D printed mold.There were 10 cases of femur and 6 cases of tibia.According to Cierny Mader’s classification of bone infection,there were 4 cases of typeⅢ,7 cases of typeⅠ+typeⅢ,and 5 cases of typeⅠ+typeⅣ.The time from the first(surgical)treatment to the initial infection was 0.5-120 months and the duration of infection was 0.5-118 months.In the intramedullary nail fixation group,the soft tissue scar,granulation tissue and dead bone at the infected fracture end and the interlocking screw were completely removed after the removal of intramedullary nail.The soft tissue involved in infection was removed for patients with sinuses and soft tissue abscesses.The necrotic and inflammatory tissues in the medullary cavity were removed with soft drill and examined.Antibiotic bone cement intramedullary nail was implanted after repeated irrigation of the medullary cavity.In the non-intramedullary nail fixation or non-fixation group,the infected broken end or focal infection site was cut open.The sinuses and infected soft tissue were removed together.The pulp was expanded according to the standard procedures of femoral or tibial intramedullary nail fixation.The other procedures were the same as before.RESULTS AND CONCLUSION:(1)All patients were followed up for 12-24 months.There was no recurrence of infection or complications.(2)One case was infected with malunion of fracture.The range of motion of the knee joint was 50 degrees in

关 键 词：股骨 胫骨 骨折相关感染 骨髓炎 髓腔感染 抗生素骨水泥 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R63