摘要
感染性骨不连同时存在骨感染和骨不连治疗困难,是骨科领域的难题。目前的治疗方法主要分为两大类:第一类为分期治疗,先清创根治感染,待感染控制后再植骨治疗骨不连,比如Masquelet技术;第二类为Ⅰ期治疗,处理骨不连的同时控制感染,比如Ilizarov技术及带血运的腓骨瓣或髂骨瓣移植等。近年来,随着药物缓释技术的发展,组织瓣联合载抗生素硫酸钙及自体髂骨颗粒混合植骨Ⅰ期治疗创伤性骨感染也取得了满意的临床疗效,应用日趋广泛。笔者采用回顾性病例系列研究分析2013年1月—2017年12月我院收治的51例四肢长骨感染性骨不连患者的临床资料,探讨组织瓣联合载抗生素硫酸钙及自体髂骨颗粒混合植骨Ⅰ期治疗方案的疗效。
Objective To investigate the clinical efficacy of tissue flap combined with antibiotic-loaded calcium sulfate and autogenous iliac bone grafting at stage I for infected nonunion of long bone.Methods A retrospective case series study was conducted to analyze the clinical data of 51 patients with infected nonunion of long bones admitted to Tongde Hospital of Zhejiang Province from January 2013 to December 2017.There were 42 males and nine females,aged 19-71 years,with an average age of 36.3 years.There were 43 patients with bone nonunion at tibia,six at femur,one at humerus,and one at ulna and radius.The range of bone defect area was 1-9 cm,with an average of 2.9 cm.On the basis of thorough debridement,tissue flaps combined with antibiotic-loaded calcium sulfate and autologous iliac bone graft were performed at stage I treatment.The survival of skin flaps,infection control,nonunion healing and complications were recorded.Johner-Wruhs joint function assessment criteria were used to evaluate limb function.Results All patients were followed up for 10-35 months,with an average of 18.3 months.All flaps survived eventually.Except for one patient with infection recurrence,the other 50 patients with infection obtained primary cure.All nonunions were healed,with an average healing time of 6.4 months ranging from 4 to 15 months.Complications included venous crisis of skin flaps in five patients,anterolateral femoral cutaneous nerve injury in 20 patients,recurrence of infection in one patient,and infection of external fixator nail tract in three patients.Function evaluation results by Johner-Wruhs criteria were excellent in 34 patients,good in 14,and moderate in three patients,with an excellent and good rate of 94%.Conclusion On the basis of thorough debridement,tissue flap combined with antibiotic-loaded calcium sulfate and autogenous iliac bone graft can control the infection effectively,promote the bone union and improve the limb function.
作者
沈立锋
张春
郭峭峰
刘亦杨
黄凯
林炳远
张展
翟利锋
Shen Lifeng;Zhang Chun;Guo Qiaofeng;Liu Yiyang;Huang Kai;Lin Bingyuan;Zhang Zhan;Zhai Lifeng(Department of Repairing and Reconstructive Center,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2019年第2期115-120,共6页
Chinese Journal of Trauma
基金
浙江省基础公益研究计划项目(GF19H060025).
关键词
骨折
不愈合
聚甲基丙烯酸类
骨移植
抗菌药
Fractures,ununited
Polymethacrylic acids
Bone transplantation
Anti-bacterial agents
