诱导膜技术治疗感染性骨缺损的疗效分析

发布时间：2018-02-01 17:52

本文关键词： 诱导膜技术感染性骨缺损清创骨水泥　出处：《中国修复重建外科杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨采用诱导膜技术治疗感染性骨缺损的疗效。方法 2011年1月—2014年6月,采用诱导膜技术治疗感染性骨缺损36例37处创伤。其中男28例,女8例;年龄20~68岁,平均36岁。均为创伤后发生感染性骨缺损,骨缺损位于胫腓骨24例25处,股骨6例6处,尺桡骨2例2处,跟骨3例3处,锁骨1例1处。发病至采用诱导膜技术治疗时间为0.5~36.0个月,平均6.2个月;其中15例患者为急性感染(病程3个月)。一期手术去除内固定物后,彻底清除感染坏死的骨组织及周围软组织,并在骨缺损处填充含抗生素骨水泥块;彻底清创后如果存在骨折不稳,则以外固定支架或石膏予以稳定;术后给予敏感抗生素。二期(一般一期术后6~8周)取出骨水泥,小心保护由骨水泥诱导形成的诱导膜,并在诱导膜内填充颗粒状自体髂骨。结果清创术后患者住院时间17~30 d,平均22.2 d;二期术后住院时间7~14 d,平均10 d。16例清创术后行局部皮瓣移位或游离皮瓣移植覆盖创面者,术后皮瓣均成活。1例股骨骨折患者术后11个月感染复发改行Ilizarov技术治疗;1例股骨远端骨折患者术后1个月感染复发最终行截肢术;1例胫腓骨远端骨折患者清创术后感染未能控制,后行多次清创术并最终行踝关节融合;1例胫腓骨骨折患者失访;余32例33处获随访,随访时间1~5年,平均2年。感染控制率91.7%(33/36)。患者骨折均达骨性愈合,愈合时间4~12个月,平均7.5个月;均无再骨折发生。其中1例股骨干骨缺损患者侧方成角15°,下肢短缩1.5 cm;7例出现钉道感染,经口服抗生素及钉道护理后好转。末次随访时,6例关节周围骨缺损患者邻近关节功能受限。结论采用诱导膜技术治疗感染性骨缺损,操作简便,不受限于骨缺损大小,疗效满意。
[Abstract]:Objective to evaluate the efficacy of induction membrane technique in the treatment of infectious bone defects. Methods from January 2011 to June 2014. Thirty-six patients (28 males and 8 females) with infectious bone defects were treated with inductive membrane technique. The age was 20 to 68 years old (mean 36 years). The bone defects were found in 24 cases (25 cases) of tibia and fibula, 6 of femur (6 cases), 2 of ulna and radius (2 cases) and 3 of calcaneus (3 cases). One case had one clavicle. The time from onset to treatment with induction membrane technique was 0.5 ~ 36.0 months (mean 6.2 months). 15 of them were acute infection (the course of the disease was 3 months). After removing the internal fixation, the infected and necrotic bone tissue and surrounding soft tissue were completely removed, and the antibiotic bone cement was filled in the bone defect. If the fracture is unstable after thorough debridement, the external fixator or gypsum should be stabilized. After operation, sensitive antibiotics were given. Bone cement was removed from the second stage (6 ~ 8 weeks after normal primary operation) and carefully protected from the induction membrane induced by bone cement. The autologous iliac bone was filled in the inductive membrane. Results the hospitalization time of the patients after debridement was 1730 days with an average of 22.2 days. The average length of hospitalization was 10 d.16 cases after debridement or local flap transfer or free flap transplantation to cover the wound. Postoperative flap survival in 1 cases of femoral fracture patients 11 months after the recurrence of infection was changed to Ilizarov treatment; One patient with distal femur fracture received amputation one month after operation. One patient with distal tibia and fibula fracture could not control the infection after debridement and had multiple debridement and ankle fusion. One case of tibia and fibula fracture was lost. The other 32 cases (33 cases) were followed up for 1 ~ 5 years (mean 2 years). The infection control rate was 91.7% and 33 / 36%. The fracture healing time was 4 ~ 12 months. Average 7.5 months; No refracture occurred, including 1 case with femoral shaft bone defect with lateral angle of 15 掳and lower extremity shortening of 1.5 cm. There were 7 cases of nail infection, which were improved by oral antibiotics and nursing care. At the last follow-up, 6 patients with peripheral bone defects had limited function of adjacent joints. Conclusion Induction membrane technique is used to treat infectious bone defects. The operation is simple, not limited to the size of bone defect, and the curative effect is satisfactory.
【作者单位】：南京大学医学院附属鼓楼医院骨科;
【基金】：江苏省青年医学人才项目(QNRC2016009) 南京市卫生局重点项目(ZKX16034)~~
【分类号】：R687.3
【正文快照】： 随着社会发展,高能量损伤患者明显增加,内植物应用也更加广泛,与之伴随的创伤及创伤术后骨感染患者也明显增多[1]。对于这类创伤后骨感染患者,传统治疗方法是彻底清创,抗生素骨水泥链珠填充死腔,必要时软组织修复创面,二期取出骨水泥链珠,再行植骨[2]。针对骨缺损较大的患者,

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