胫骨远端皮质开窗后扩髓结合载抗生素硫酸钙治疗胫骨髓内钉固定术后慢性骨髓炎的疗效分析  

Reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate for treatment of chronic tibial osteomyelitis after intramedullary nail fixation

作　　者：许毅博 马腾[1] 任程[1] 李明[1] 路遥[1] 孙亮[1] 黄强[1] 王谦[1] 薛汉中[1] 李忠[1] 张堃[1] Xu Yibo;Ma Teng;Ren Cheng;Li Ming;Lu Yao;Sun Liang;Huang Qiang;Wang Qian;Xue Hanzhong;Li Zhong;Zhang Kun(Department of Trauma Orthopaedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科下肢病区,西安710054

出　　处：《中华创伤骨科杂志》2022年第10期884-891,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨胫骨远端皮质开窗后扩髓清创结合载抗生素硫酸钙人工骨髓内填充及胫骨开槽抗生素骨水泥填充治疗胫骨髓内钉固定术后慢性骨髓炎的早期疗效。方法回顾性研究2019年1月至2021年1月西安交通大学附属红会医院创伤骨科下肢病区收治的20例胫骨髓内钉固定术后慢性骨髓炎患者资料。根据手术方式不同分为扩髓组和开槽组。扩髓组9例,男6例,女3例;年龄为(47.6±11.4)岁。开槽组11例,男9例,女2例;年龄为(49.2±13.9)岁。比较两组患者感染持续时间、手术时间、术中出血量、细菌培养结果、总住院时间、炎性指标恢复正常时间、下地负重时间、并发症发生率、感染控制率、Johner-Wruhs关节功能评分优良率。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~25个月随访。两组患者的感染持续时间、手术时间、术中出血量、细菌培养结果、炎性指标恢复正常时间、并发症发生率、感染控制率、Johner-Wruhs评分优良率比较差异均无统计学意义(P>0.05)。扩髓组患者的总住院时间[(11.7±4.7)d]、下地负重时间[(5.8±1.6)周]显著短于开槽组[(16.8±4.6)d、(8.1±2.9)周],差异均有统计学意义(P<0.05)。结论相比较传统胫骨开槽灌洗结合抗生素骨水泥填充,胫骨远端开窗后扩髓清创结合硫酸钙髓内填充治疗胫骨慢性骨髓炎同样可以有效控制感染,获得良好的功能,同时后者允许患者更早负重,缩短治疗周期。Objective To compare the early clinical efficacy between reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate and trench grooving combined with polymethyl methacrylate(PMMA)for the treatment of chronic tibial osteomyelitis after intramedullary nail fixation.Methods A retrospective analysis was conducted in the 20 patients who had been surgically treated for chronic tibial osteomyelitis after intramedullary nail fixation at Department of Trauma Orthopaedics,Honghui Hospital from January 2019 to January 2021.According to the surgical methods,they were divided into a reaming group and a grooving group.In the reaming group,there were 6 males and 3 females with an age of(47.6±11.4)years;in the grooving group,there were 9 males and 2 females with an age of(49.2±13.9)years.The 2 groups were compared in terms of duration of infection,operation time,intraoperative blood loss,bacterial culture results,total hospital stay,time for inflammatory indexes to return to normal,time for weight-bearing,complication rate,infection control rate,and good to excellent rate by Johner-Wruhs joint function scoring.Results There was no significant difference in the preoperative general data between the 2 groups,showing they were comparable(P>0.05).All patients were followed up for 12 to 25 months after operation.There were no significant differences in the duration of infection,operation time,intraoperative blood loss,bacterial culture results,time for inflammatory indexes to return to normal,complication rate,infection control rate,or Johner-Wruhs scoring between the 2 groups(P>0.05).The total hospital stay[(11.7±4.7)d]and weight-bearing time[(5.8±1.6)weeks]for the reaming group were significantly shorter than those for the grooving group[(16.8±4.6)d and(8.1±2.9)weeks](P<0.05).Conclusion In the treatment of chronic tibial osteomyelitis after intramedullary nail fixation,compared with conventional trench grooving combined with PMMA,reaming after distal tibia cortical fenestration combined

关 键 词：胫骨 骨折固定术 内 髓内 骨髓炎 扩髓 硫酸钙 

分 类 号：R687.3[医药卫生—骨科学]