膜诱导技术治疗感染性骨缺损临床循证指南(2023版)  

An evidence‑based clinical guideline for the treatment of infectious bone defect with induced membrane technique(version 2023)

作　　者：中华医学会骨科学分会 沈杰 陈林 董世武 傅景曙 官建中[6] 何洪波[7] 侯春丽 侯志勇[8] 李刚[9] 李杭[10] 刘凤祥[11] 刘雷[12] 马锋[13] 聂涛[14] 覃承诃[15] 石健 舒衡生[17] 孙东 孙立[18] 王光林[19] 汪小华 王志强[20] 吴宏日 邢军超 许建中 徐永清 杨大威[21] 于腾波[22] 袁志 张文明[24] 赵枫 郑佳状[20] 周大鹏 朱晨 朱跃良 谢肇 吴新宝[28] 张长青[29] 唐佩福[30] 张英泽[8] 罗飞 Chinese Orthopedic Association;Shen Jie;Chen Lin;Dong Shiwu;Fu Jingshu;Guan Jianzhong;He Hongbo;Hou Chunli;Hou Zhiyong;Li Gang;Li Hang;Liu Fengxiang;Liu Lei;Ma Feng;Nie Tao;Qin Chenghe;Shi Jian;Shu Hengsheng;Sun Dong;Sun Li;Wang Guanglin;Wang Xiaohua;Wang Zhiqiang;Wu Hongri;Xing Junchao;Xu Jianzhong;Xu Yongqing;Yang Dawei;Yu Tengbo;Yuan Zhi;Zhang Wenming;Zhao Feng;Zheng Jiazhuang;Zhou Dapeng;Zhu Chen;Zhu Yueliang;Xie Zhao;Wu Xinbao;Zhang Changqing;Tang Peifu;Zhang Yingze;Luo Fei(不详;First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Daping Hospital of Army Medical University,Chongqing 400042,China;Army Medical University,Chongqing 400038,China;Banan Hospital of Chongqing Medical University,Chongqing 401320,China;First Affiliated Hospital of Bengbu Medical College,Bengbu 233099,China;Xiangya Hospital of Central South University,Changsha 410008,China;Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Faculty of Medicine,Chinese University of Hong Kong,Hong Kong 999077,China;Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Eighth Affiliated Hospital of Sun Yat‑sen University,Shenzhen 518033,China;Ningxia Autonomous Region People′s Hospital,Yinchuan 750021,China;First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Nanfang Hospital of Southern Medical University,Guangzhou 510515,China;15920th Hospital of PLA Joint Logistics Support Force,Kunming 650032,China;Tianjin Hospital,Tianjin 300211,China;Guizhou Provincial People′s Hospital,Guiyang 550002,China;West China Hospital of Sichuan University,Chengdu 610041,China;Suining Central Hospital,Suining 629099,China;Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Affiliated Hospital of Qingdao University,Qingdao 266000,China;Xijing Hospital,Air Force Medical University,Xi′an 710032,China;First Affiliated Hospital of Fujian Medical

机构地区：[1]不详 [2]陆军军医大学第一附属医院,重庆400038 [3]陆军军医大学大坪医院,重庆400042 [4]陆军军医大学,重庆400038 [5]重庆医科大学附属巴南医院,重庆401320 [6]蚌埠医学院第一附属医院,蚌埠233099 [7]中南大学湘雅医院,长沙410008 [8]河北医科大学第三医院,石家庄050051 [9]香港中文大学医学院,中国香港999077 [10]浙江大学医学院附属第二医院,杭州310009 [11]上海交通大学医学院附属第九人民医院,上海200011 [12]中山大学附属第八医院,深圳518033 [13]宁夏自治区人民医院,银川750021 [14]南昌大学第一附属医院,南昌330006 [15]南方医科大学南方医院,广州510515 [16]解放军联勤保障部队第九二〇医院,昆明650032 [17]天津市天津医院,天津300211 [18]贵州省人民医院,贵阳550002 [19]四川大学华西医院,成都610041 [20]遂宁市中心医院,遂宁629099 [21]哈尔滨医科大学附属第四医院,哈尔滨150001 [22]青岛大学附属医院,青岛266000 [23]空军军医大学西京医院,西安710032 [24]福建医科大学第一附属医院,福州350005 [25]解放军联勤保障部队第九一〇医院,泉州362008 [26]解放军北部战区总医院,沈阳110015 [27]中国科技大学附属第一医院,合肥230001 [28]北京积水潭医院,北京100035 [29]上海市第六人民医院,上海200233 [30]中国人民解放军总医院,北京100853

出　　处：《中华创伤杂志》2023年第2期107-120,共14页Chinese Journal of Trauma

基　　金：军队卫勤重大专项课题(AWS17J004);重庆英才项目(cstc2022ycjh‑bgzxm0104)。

摘　　要：感染性骨缺损是指伴有感染或在骨感染治疗过程中产生的骨质缺损,需要外科干预,但治疗过程繁琐而复杂:既要控制骨感染又要修复骨缺损,有时还涉及复杂的软组织重建,任何环节未达到相应的目标都可能导致整体治疗失败。因此,感染性骨缺损一直是骨科领域的世界性难题。常规治疗方法主要为彻底清创、植骨或骨搬移、全身及局部抗生素应用。彻底外科清创是控制感染的重要基石,而清创范围、骨缺损重建时机和方式长期存在争议。随着膜诱导技术的临床应用,感染性骨缺损的治疗在有效感染控制和快速缺损修复方面取得重要进展。越来越多的临床骨科医师开始关注膜诱导技术,但因忽略骨感染控制的基本原理和技术细节,其疗效受到影响,甚至导致并发症。为此,中华医学会骨科学分会组织国内骨科领域相关专家,依据循证医学方法制订《膜诱导技术治疗感染性骨缺损临床循证指南(2023版)》,从感染性骨缺损的精准诊断、术前评估、手术过程及术后管理和康复等方面提出推荐建议,为膜诱导技术治疗感染性骨缺损的临床实践提供有价值的参考。Infectious bone defect is bone defect with infection or as a result of treatment of bone infection.It requires surgical intervention,and the treatment processes are complex and long,which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases.Failure to achieve the goals in any step may lead to the failure of the overall treatment.Therefore,infectious bone defect has been a worldwide challenge in the field of orthopedics.Conventionally,sequestrectomy,bone grafting,bone transport,and systemic/local antibiotic treatment are standard therapies.Radical debridement remains one of the cornerstones for the management of bone infection.However,the scale of debridement and the timing and method of bone defect reconstruction remain controversial.With the clinical application of induced membrane technique,effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect.The induced membrane technique has attracted more interests and attention,but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur.Therefore,the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence‑based clinical guideline for the treatment of infectious bone defect with induced membrane technique(version 2023)according to the evidence‑based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis,preoperative evaluation,operation procedure,postoperative management and rehabilitation,so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

关 键 词：骨 感染 清创术 骨移植 指南 

分 类 号：R68[医药卫生—骨科学]