En-Bloc切除式清创后骨搬运联合锁定钢板治疗股骨髁上Cierny-MaderⅣ型感染性骨缺损的疗效分析  

Staged treatment of infectious femoral defects of Cierny-Mader typeⅣusing bone transport combined with locking plating after En-Bloc resection debridement

作　　者：赵刚 罗文明 李保杰 刘振 于平 孙学成[1] Zhao Gang;Luo Wenming;Li Baojie;Liu Zhen;Yu Ping;Sun Xuecheng(Department of Orthopaedics,Weifang People's Hospital,Weifang 261000,China)

机构地区：[1]山东省潍坊市人民医院骨科,潍坊261000

出　　处：《中华创伤骨科杂志》2024年第7期597-603,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨En-Bloc切除式清创后骨搬运联合锁定钢板(BTLP)分期治疗股骨髁上Cierny-MaderⅣ型感染性骨缺损的疗效。方法回顾性分析2020年1月至2023年1月山东省潍坊市人民医院骨科收治的10例股骨髁上感染性骨缺损患者资料。男8例,女2例;年龄(48.5±11.4)岁;Cierny-Mader解剖分型均为Ⅳ型;所有患者一期En-Bloc切除式清创后拆除原有内固定物,缺损处填塞抗生素骨水泥,感染控制后二期行手术取出骨水泥,重新内固定并外固定支架辅助搬运,待搬运骨段会师后,将断端新鲜化和少量植骨,螺钉锁定搬运骨段后拆除外固定支架,等待矿化及会师端的愈合。术后记录患者骨缺损长度、外固定支架带架时间和指数、骨愈合时间、肢体功能活动及并发症发生情况。结果10例患者一期清创后形成(9.1±2.1)cm的骨缺损,所有患者随访时间为(19.8±6.6)个月,外固定支架带架时间为(107.2±25.1)d,带架指数为(11.8±0.5)d/cm。术后无一例患者复发,9例患者于术后8个月内获得骨愈合;1例因会师端愈合欠佳,行二次植骨治疗后骨愈合。所有患者恢复原本生活或体力劳动,无疼痛及再骨折等并发症发生。3例患者出现膝关节不同程度僵硬,但能满足日常生活;1例患者要求行关节松解术,疗效满意。结论En-Bloc切除式清创后BTLP分期治疗股骨髁上Cierny-Mader解剖Ⅳ型感染性骨缺损是一种有效的方法。ObjectiveTo investigate the efficacy of staged treatment of infectious femoral defects of Cierny-Mader typeⅣusing bone transport combined with locking plating after En-Bloc resection debridement.MethodsA retrospective analysis was conducted of the 10 patients with distal femoral traumatic bone infection who had been treated at Department of Orthopedics,The People's Hospital of Weifang from January 2020 to January 2023.There were 8 males and 2 females with an age of(48.5±11.4)years.All cases were classified as Cierny-Mader typeⅣ.At the first stage,En-Bloc resection debridement was performed in all cases to remove previous internal fixation devices and fill the defects with antibiotic bone cement.After infection control,the second stage involved removal of bone cement,re-fixation with internal devices,and external fixation support for bone transport.After the bone segments met,freshening of the bone ends,minor bone grafting,and screw locking of the transported bone segments were performed.Outcomes observed included bone defect length,frame carrying time and index,bone healing time,limb function,and complications.ResultsAfter the first stage of debridement,a bone defect of(9.1±2.1)cm was created in 10 patients.All patients were followed up for(19.8±6.6)months.The duration for carrying external fixation frame was(107.2±25.1)days,and the frame index(11.8±0.5)d/cm.No recurrence was observed postoperatively.Bone union was achieved in 9 patients within 8 months,but in 1 patient only after secondary bone grafting due to poor healing at the meeting ends.All patients returned to their previous life or physical labor with no complications like pain or re-fracture.Three patients experienced varying degrees of knee joint stiffness,but were able to meet needs of daily life;one requested joint release surgery which resulted in satisfactory therapeutic efficacy.ConclusionStaged treatment of infectious femoral defects of Cierny-Mader typeⅣusing bone transport combined with locking plating after En-Bloc resection debride

关 键 词：骨髓炎 股骨骨折 清创术 骨缺损 助骨搬运 

分 类 号：R687.3[医药卫生—骨科学]