警惕严重开放性骨折后隐匿的骨折相关感染  

Be alert to insidious fracture-related infections secondary to severe open fractures

作　　者：滕星[1] 杨胜松[1] 王陶[1] 公茂琪[1] 蒋协远[1] 黄雷 Teng Xing;Yang Shengsong;Wang Tao;Gong Maoqi;Jiang Xieyuan;Huang Lei(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,The Fourth Clinical Medical Cellege,Peking University,Beijing 100035,China)

机构地区：[1]北京积水潭医院,北京大学第四临床医学院创伤骨科,北京100035

出　　处：《中华创伤骨科杂志》2023年第4期289-295,共7页Chinese Journal of Orthopaedic Trauma

基　　金：首都临床特色应用研究(Z161100000516052)。

摘　　要：目的:观察临床和血清炎性标志物均正常的GustiloⅢb型开放性胫骨骨折后期遗留的骨缺损,及应用Ilizarov技术治疗的体会。方法:回顾性研究2010年1月至2021年6月期间北京积水潭医院创伤骨科收治的19例GustiloⅢb型开放性胫骨骨折后期遗留骨缺损患者资料。男15例,女4例;年龄(41±11)岁。病例纳入标准:Ilizarov技术(短缩-延长术或骨运输术)治疗,软组织修复手术创面闭合且没有临床感染征象至少3个月,血清炎性标志物均正常,随访超过取外固定支架后3个月。研究患者术前均进行三相骨扫描检查。第一次术中均行骨缺损端的扩创、细菌培养、外固定支架固定,一期或二期行截骨进行肢体延长或骨运输术。培养阳性患者术后全身应用6周敏感抗生素。记录患者术中缺损部位是否有脓液、培养结果、治疗的缺损长度、治疗过程中感染的发生比例、感染出现时间、骨折愈合率、骨愈合指数、骨性结果和功能结果。结果:19例患者从原始损伤至第一次手术间隔(10±8)个月,术前骨扫描结果:8例感染阴性,4例不除外感染,7例慢性骨髓炎。所有患者术中在折端周围均未见脓液。术中培养结果:1例培养出1份阳性结果(骨扫描提示无感染),3例培养出≥2份阳性结果(骨扫描提示无感染、可疑感染和慢性骨髓炎各1例)。骨缺损长度(8±3)cm,第一次术后随访(37±15)个月。所有患者均骨折愈合,骨愈合指数(1.7±0.5)月/cm。治疗期间6例患者于第一次术后1(1,1)个月出现临床感染征象,均是术中培养阴性的患者。6例患者中5例经过全身应用经验抗生素保守治疗,1例经过再次扩创治疗。6例患者经过治疗后均无临床复发表现。所有患者骨性结果优16例,良3例;功能结果优10例,良9例。结论:针对GustiloⅢb型严重开放性骨折后期遗留的骨缺损,即使临床和血清炎性标志物检查均正常,仍要警惕存在低毒性感染。重�Objective To report our experience in using the Ilizarov technique to treat bone defects secondary to GustiloⅢb open tibial fractures with negative clinical signs and serological inflammatory markers.Methods A retrospective study was performed to analyze the 19 patients with bone defects secondary to GustiloⅢb open tibial fracture who had been treated at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital between January of 2010 and June of 2021.They were 15 males and 4 females with an age of(41±11)years.Their inclusion criteria:undergoing treatment with Ilizarov technique(consecutive compression-distraction or bone transport),soft tissue coverage procedures resulting in wound closure and negative clinical infection signs for at least 3 months and normal serological inflammatory markers,and follow-up for more than 3 months after frame removal.Three-phase bone scan was performed for the patients before the present surgery.Debridement,sampling of deep tissues for bacterial culture,and external stabilization with a fixator were performed in the present surgery.Osteotomy for compression-distraction or bone transport technique was carried out at 1 stage or 2 stages.Systemic antibiotic therapy for 6 weeks was continued for those with positive microbiological analysis guided by antibiogram.Recorded were results of intra-operative pus detection around defects,microbiological findings,length of bone defect reconstructed,rate and time of infection recurrence during treatment,fracture union rate,bone healing index,bony and functional results.Results The interval between primary injury to the present surgery was(10±8)months.The preoperative three-phase bone scan showed infection free in 8 cases,chronic osteomyelitis in 7 cases,and suspicious infection in 4 cases.No pus was found during intra-operative debridement in all.The intra-operative microbiological detection was positive in 1 sample in 1 patient(infection free indicated by bone scan),and in≥2 samples in 3 patients(bone scan indicating non-in

关 键 词：骨髓炎 骨折 不愈合 微生物学 骨折相关感染 胫骨骨缺损 伊利扎罗夫技术 

分 类 号：R683[医药卫生—骨科学]