膜诱导技术在指骨或趾骨骨髓炎手术治疗中的应用  

Application of induced membrane technique in surgical treatment of phalangeal osteomyelitis of the hand or foot

作　　者：韩正锋[1] 尹建[1] 商俊刚 崔勇[1] HAN Zhengfeng;YIN Jian;SHANG Jungang;CUI Yong(Department of Orthopedics,Beijing Chuiyangliu Hospital,Beijing 100021,China)

机构地区：[1]北京市垂杨柳医院骨三科,北京100021

出　　处：《中国骨与关节损伤杂志》2024年第10期1054-1057,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的介绍膜诱导技术在指骨或趾骨骨髓炎手术治疗中应用方法。方法回顾性分析自2021-03—2022-07诊治的5例指骨或趾骨骨髓炎,一期手术对感染组织进行彻底清创,用抗生素骨水泥填充骨缺损部位,闭合切口,术后静脉应用抗生素1周。二期手术于感染控制后进行,移除骨水泥间隔物,保护诱导膜,骨端再次清创后用自体髂骨移植并固定,无张力下缝合诱导膜。结果5例术后均获得随访,随访时间分别为10、14、16、17、32个月。一期手术后所有患者骨髓炎均得到控制,随访期间均未出现骨髓炎复发。近侧指间关节骨髓炎患者和第2趾中节趾骨骨髓炎患者感染控制后拒绝接受二期手术。末节指骨近端累及远侧指间关节骨髓炎患者(一期手术后6周)和远侧指间关节骨髓炎患者(一期手术后8周)行指间关节植骨融合,末节指骨骨髓炎患者一期手术后6周进行末节远端植骨,患者指甲和甲床均得到保留。指间关节融合患者因不能耐受克氏针对日常生活的影响,分别于术后6周、术后9周取出克氏针,之后继续支具外固定2~3个月后获得骨愈合。1例对指甲外形不满意,其余4例对手指或足趾的外形及功能很满意。结论膜诱导技术应用于指骨或趾骨骨髓炎手术治疗中是可行的,可以为骨缺损修复创造条件,最大限度恢复手指或足趾的长度,进而获得满意的外观及功能。Objective To introduce the application of induced membrane technique in surgical treatment of phalangeal osteo⁃myelitis of the hand or foot.Methods Five patients treated for phalangeal osteomyelitis of hand or foot from March 2021 to Ju⁃ly 2022 were retrospectively analyzed.The first surgical stage included debridement of infected tissues,insertion of an antibiotic cement spacer into the bone defect,closure of the wound,and administration of antibiotics intravenously for one week.The sec⁃ond surgical stage was performed after infection was controlled.It included removal of the cement spacer,preservation of the membrane,insertion and fixation of autologous bone grafts after repeat debridement of the bone edges,closure of the membrane containing graft without tension.Results All five patients were followed up after surgery,the follow-up periods were 10,14,16,17 and 32 months respectively.All bone infections were controlled after the first surgical stage,and there was no recurrence during follow-up.The patient with proximal interphalangeal joint osteomyelitis and the patient with middle phalanx osteomyeli⁃tis of second toe refused the second stage operation after their infections had been controlled.For the patient with distal phalan⁃geal osteomyelitis and the distal interphalangeal(DIP)joint involved,and the patient with DIP joint osteomyelitis,arthrodesis with autologous bone grafts at DIP joint was performed 6 and 8 weeks after the first surgical stage respectively.The patient with distal phalangeal osteomyelitis accepted distal stump bone graft 6 weeks after the first surgical stage.Nail plate and matrix units were preserved in all 3 patients.Due to the intolerance of K-wire’s impact on daily life,two patients who underwent DIP ar⁃throdesis had their K-wires removed 6 and 9 weeks after the second surgical stage respectively,then they continued with exter⁃nal fixation brace treatment for another 2-3 months until bone healing was achieved.One patient was dissatisfied with nail shape,while all the o

关 键 词：指骨 趾骨 骨髓炎 膜诱导技术 骨缺损 骨移植 

分 类 号：R687.3[医药卫生—骨科学]