摘要
目的 探讨Masquelet膜诱导技术结合被覆抗生素骨水泥髓内钉固定治疗下肢大段感染性骨缺损的临床疗效.方法 回顾性分析2009年6月至2015年8月治疗并获随访的53例下肢大段感染性骨缺损患者资料,男40例,女13例;年龄23～61岁,平均（36.2±8.4）岁;其中37例继发于骨折术后感染,16例由开放性骨折所致;股骨干17例,胫骨干36例.53例患者均采用膜诱导技术治疗：第1阶段行感染病灶彻底清创,于骨缺损处填充混有敏感或广谱抗生素的骨水泥占位,并临时固定,感染控制后更换敏感抗生素骨水泥占位器诱导成膜并联合应用被覆抗生素骨水泥髓内钉固定.第2阶段,髓内钉固定术后4～6周去除骨水泥并行自体松质骨颗粒植骨,而后诱导膜覆盖缝合切口.观察感染治愈率、骨愈合时间及相关并发症发生情况.结果 53例患者术后获24～63个月,平均（39±4.7）个月随访.一期清创后骨缺损长度6～15cm,平均（8.7±4.9） cm.49例患者术后12个月内感染治愈、骨缺损愈合,骨性愈合时间为5.3～9.7个月,平均（7.4±3.2）个月,无一例发生再骨折.胫骨愈合时间平均（7.8±2.1）个月,股骨愈合时间平均（7.2±3.9）个月.1例股骨干缺损患者膜诱导植骨术后4个月感染复发,再次清创植入敏感抗生素骨水泥占位器重新开始第一阶段治疗,6周后感染控制行第二阶段治疗.3例患者（2例股骨干,1例胫骨干）术后3～6个月出现植骨吸收,未见骨缺损区骨密度增高,再次植骨治疗后均在术后8个月内骨缺损治愈.结论 Masquelet膜诱导技术结合被覆抗生素骨水泥髓内钉固定,可以在有效控制感染的同时为骨缺损修复创造良好的生物学和力学环境,具有较好的临床疗效.
Objective To explore the clinical effect of Masquelet membrane induction technique combined with antibiotic coated intramedullary nail fixation in the treatment of lower limb large segment infected bone defects.Methods From June 2009 to August 2015,53 patients who have lower limb large segment infected bone defects were analyzed retrospectively,including 40 males and 13 females,aged from 23 to 61 years,with an average age of 36.2±8.4 years.37 cases were secondary to infection after fracture surgery,and 16 cases were caused by open fractures.There were 17 cases of femoral shaft defects and 36 cases of tibia diaphysis defects.All 53 cases were treated with Masquelet technique.The first stage was infection debridement,then bone defect was filled by bone cement mixed with sensitive or broad-spectrum antibiotics,and then temporary fixation was given.When the infection was controlled,debridement was given again and sensitive antibiotic bone cement was replaced to induce membrane,and antibiotic coated intramedullary nail was used for internal fixation.In the second stage,after intramedullary nailing internal fixation for 4-6 weeks,the bone cement occupying device was taken out and the autologous cancellous bone was planted in the induced membrane.Then the membrane was covered and sutured.The cure rate of infection,the time of bone healing and the related complications were observed.Results 53 patients were followed up for 24 to 63 months （with an average of 39±4.7 months）.The length of tibia bone defect after debridement was 6-15 cm （average 8.7±4.9 cm）.49 patients＇ infection were cured in 12 months after operation,and the bone defects were healed,with healing time of 5.3-9.7 months （mean 7.4±3.2 months）.No refracture occurred.The healing time of tibia was 7.8±2.1 months,while the healing time of the femur was 7.2±3.9 months.1 case of femoral shaft defect had recurrence of infection 4 months after membrane induced bone grafting,and the first stage treatment was restarted which were debridement and implantation of sensitive antibiotic bone cement occupying device.After 6 weeks,the infection was controlled and the second stages continued.3 cases＇ s （2 cases of femoral shaft,1 case of tibial shaft） autologous cancellous bone were absorbed 3 to 6 months after operation,and no bone density increased in the bone defect area.The autologous cancellous bone was reimplanted and the bone defect was cured in 8 months.Conclusion Masquelet technology combined with antibiotic coated intramedullary nailing can effectively control infection and create a good biological and mechanical environment for bone defect repair.It has good clinical efficacy.
作者
丁国成
刘欣伟
刘兵
周大鹏
项良碧
韩天宇
田竞
解冰
Ding Guocheng;Liu Xinwei;Liu Bing;Zhou Dapeng;Xiang Liangbi;Han Tianyu;Tian Jing;Xie Bing(Dalian Medical University Graduate Training Base of Shenyang Military Region General Hospital, Shenyang 110016, China;Department of Orthopaedics, Army Severe Trauma Treatment Center, the General Hospital of Shenyang Military Region, Shenyang 110016, Chin)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第9期530-535,共6页
Chinese Journal of Orthopaedics
基金
全军重大课题项目（AWS14C003）
关键词
感染
创伤和损伤
骨折固定术
髓内
Infection
Wounds and injuries
Fracture fixation
intramedullary
