摘要
目的探讨抗生素骨水泥间置器治疗髓内固定术后骨髓炎合并骨不连的临床疗效。方法 2002年6月-2006年5月,收治12例行切开复位交锁髓内钉内固定术后骨髓炎合并骨不连患者。男8例,女4例;年龄26～53岁,平均40.2岁。骨折部位:胫骨7例,股骨5例。髓内固定术后2周内感染7例,3个月内感染5例。患者于感染发生后1～24个月入院,平均5个月。细菌培养10例呈阳性,2例呈阴性。白细胞计数、红细胞沉降率、高敏C反应蛋白均高于正常值。一期手术取出内固定物,髓内插入抗生素骨水泥间置器临时固定;3～6个月待感染控制后,二期手术取出间置器,行自体髂骨植骨锁定钢板内固定术。结果患者两期手术切口均Ⅰ期愈合,无早期相关并发症发生。二期术后患者均获随访,随访时间24～48个月,平均34个月。二期术后3个月红细胞沉降率、白细胞计数以及高敏C反应蛋白均正常。X线片复查,骨折均在二期术后10～14周达临床愈合,平均12周。除1例患者膝关节屈曲约90°外,其余患者下肢功能均恢复正常。随访期间均无感染复发。结论采用抗生素骨水泥间置器临时固定可以有效控制感染,待感染控制后二期手术取出间置器行植骨内固定,是治疗髓内固定术后骨髓炎合并骨不连的有效方法之一。
Objective To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyelitis and nonunion of bone caused by intramedullary fixation. Methods Between June 2002 and May 2006, 12 patients with chronic osteomyelitis and nonunion of bone caused by intramedullary nailing were treated, including 8 males and 4 females with an average age of 40.2 years （range, 26-53 years）. The fracture locations included tibia in 7 cases and femur in 5 cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months （range, 1-24 months）. The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell （WBC） count, erythrocyte sedimentation rate （ESR）, and C-reactive protein （CRP） were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyelitis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months. Results All wounds healed by first intention without early complication. All cases were followed up 24 to 48 months （mean, 34 months）. WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture healing at 10-14 weeks after operation （mean, 12 weeks）. Expect one patient had knee range of motion of 90°, the lower limb function of the others returned to normal. No infection recurred during follow-up. Conclusion Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nailing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effictive and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nailing.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第8期972-975,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
抗生素骨水泥间置器
骨髓炎
骨不连
髓内固定术
Antibiotic-impregnated cement temporary spacer Osteomyelitis Bone nonunion Intramedullary nailing
