骨水泥填塞联合Ilizarov技术分期治疗感染性第1跖趾关节痛风石并骨缺损  

Bone cement packing combined with Ilizarov technique in the staged treatment of infected first metatarsophalangeal joint tophi and bone defects

作　　者：谢杰伟[1] 陈谱 管华[1] 刘毅[1] 黄伟明[1] 冯恩辉 何剑波[1] 梁家畅 XIE Jiewei;CHEN Pu;GUAN Hua;LIU Yi;HUANG Weiming;FENG Enhui;HE Jianbo;LIANG Jiachang(Department of Trauma and Foot-Ankle Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院创伤足踝科,广州510120

出　　处：《中华骨与关节外科杂志》2023年第9期813-817,共5页Chinese Journal of Bone and Joint Surgery

基　　金：广东省软科学研究计划项目(2020A1414040031);广东省中医院中医药科学技术研究拔尖人才专项项目(BJ2022YL13);2023年度广州市基础与应用基础研究专题项目(2023A04J0462)。

摘　　要：目的:探讨骨水泥填塞联合Ilizarov技术分期治疗感染性第1跖趾关节痛风石并骨缺损的临床疗效。方法:收集2018年6月至2022年6月使用骨水泥填塞联合Ilizarov技术分期治疗的感染性第1跖趾关节痛风石并骨缺损患者7例,男6例,女1例,痛风石破溃时间3 d至1年。所有患者均一期行痛风石切除、修整被破坏的第1跖骨远端及近节趾骨近端,使用骨水泥进行临时填塞,待感染控制后二期行外固定器骨延长术。评估患者治疗前后疼痛视觉模拟评分(VAS)、美国矫形外科足踝协会(AOFAS)评分、畸形矫正程度和并发症情况。结果:所有患者二期手术切口均一期愈合,无针道感染,后期无应力性骨折发生。患者第1跖骨平均延长(21.1±5.3)mm,拆除外固定器时间12~16周,拆除后患者均能完全负重行走。术前VAS评分为(8.4±1.5)分,AOFAS评分为(49.3±6.7)分;末次随访时,VAS评分为(1.1±0.6)分,AOFAS评分为(82.9±7.2)分,均显著优于术前(t=25.421,P<0.001;t=31.519,P<0.001)。结论:骨水泥填塞联合Ilizarov技术治疗感染性第1跖趾关节痛风石并骨缺损,可以有效控制感染,恢复第1跖列长度,临床疗效满意,是一种安全、有效的治疗方法。Objective:To investigate the clinical effect of bone cement packing combined with Ilizarov technique in the staged treatment of infected first metatarsophalangeal joint tophi and bone defects.Methods:From June 2018 to June 2022,7 patients with infected first metatarsophalangeal joint tophi and bone defects were treated by bone cement packing combined with Ilizarov technique,including 6 males and 1 female.The rupture time of tophi ranged from 3 days to 1 year.In the first stage,tophi was removed,the distal end of the first metatarsal bone and the proximal end of the proximal phalanx were repaired,and bone cement was used for temporary packing.After the infection was controlled,Ilizarov technique was used for fixation and extension in the second stage.The visual analogue scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)score,the degree of deformity correction and complications were evaluated before and after treatment.Results:All the incisions healed at stageⅠwithout pin tract infection or stress fracture.The average length of the first metatarsal bone lengthened was(21.1±5.3)mm.The time of removing the external frame ranged from 12 weeks to 16 weeks.The preoperative VAS score was 8.4±1.5 and the AOFAS score was 49.3±6.7.At the last follow-up,VAS score was 1.1±0.6 and AOFAS score was 82.9±7.2,which were significantly better than those before operation(t=25.421,P<0.001;t=31.519,P<0.001).Conclusions:Bone cement packing combined with Ilizarov technique in the treatment of infected first metatarsophalangeal tophi and bone defects can effectively control the infection and restore the length of the first metatarsophalangeal joint.It is a safe and effective treatment method.

关 键 词：感染性痛风石 骨缺损 跖趾关节 ILIZAROV技术 骨水泥填塞 

分 类 号：R682.6[医药卫生—骨科学]