论文部分内容阅读
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7～14d,平均10d.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.“,”Objective To evaluate the effectiveness of induced membrane technique in the treatment of infectious bone defect.Methods Thirty-six patients (37 bone lesions) with infectious bone defects were treated with induced membrane technique between January 2011 and June 2014.There were 28 males and 8 females with an average age of 36 years (range,20-68 years).All bone defects were post-traumatic infectious bone defect.The bone defect was located at the tibia and fibula in 24 cases (25 bone lesions),at femurs in 6 cases (6 bone lesions),at ulnas and radii in 2 cases (2 bone lesions),at calcanei in 3 cases (3 bone lesions),and at clavicle in 1 case (1 bone lesion).The average time between onset and the treatment of induced membrane technique was 6.2 months (range,0.5-36.0 months);15 patients were acute infections (disease duration was less than 3 months).At the first stage,after the removal of internal fixator (applicable for the patients who had internal fixation),complete debridement of infection necrotic bone tissue and surrounding soft tissue was performed and the bone defects were filled with antibiotic-impregnated cement spacers.If the bone was unstable after debridement,external fixator or plaster could be used for stabilization.Patients received sensitive antibiotics postoperatively.At the second stage (usually 6-8 weeks later),the cement spacer were removed,with preservation of the induced membrane formed by the spacer,and filled the bone defect with autologous iliac bone graft within the membrane.Results The hospitalization time after debridement was 17-30 days (mean,22.2 days),and the hospitalization time after the second stage was 7-14 days (mean,10 days).All the flaps healed uneventfully in 16 cases treated with local flap transposition or free flap grafting after debridement.One patient of femur fracture received llizarov treatment after recurrence of infection at 11 months after operation;1 patient of distal femoral fracture received amputation after recurrence of infection at 1 month after operation;1 patient of distal end of tibia and fibula fractures received ankle arthrodesis after repeated debridements due to the recurrence of infection;1 patient of tibia and fibula fractures lost to follow-up.The other 32 patients (33 bone lesions) were followed up 1-5 years (mean,2 years) without infection recurrence,and the infection control rate was 91.7％ (33/36).All the patients had bony union,and the healing time was 4-12 months (mean,7.5 months);no refracture occurred.One patient of femur bone defect had a lateral angulation of 15° and leg discrepancy of 1.5 cm.Superficial pin infection was observed in 7 cases and healed after intensive wound care and oral antibiotics.Adjacent joint function restriction were observed in 6 cases at last follow-up.Conclusion Induced membrane technique is a simple and reliable technique for the treatment of infectious bone defect.The technique is not limited to the size of the bone defect and the effectiveness is satisfactory.