诱导膜联合骨搬运技术治疗胫骨骨髓炎并节段性骨缺损的疗效分析
摘要
目的:探讨采用诱导膜技术联合骨搬运技术治疗胫骨骨髓炎并节段性骨缺损的临床疗效。方法:回顾分析2013年1月至2017年9月本院创伤骨科采用诱导膜技术联合骨搬运技术治疗的18例胫骨骨髓炎并节段性骨缺损患者的临床资料。其中7例为左侧胫骨骨缺损,11例为右侧胫骨骨缺损。术后分析所有患者的骨临床愈合时间、愈合率、并发症的发生例数、Karistrom和Olemd膝、踝关节功能评分、术后疼痛视觉模拟评分(VAS)等情况。结果:第一阶段手术后,1例出现小腿深部感染,因感染未能控制,后期行截肢手术。第二阶段手术后,3例在牵张后期出现对合端愈合不良,3例遗留膝关节僵硬并疼痛,4例出现针孔感染,经治疗后感染、僵硬及疼痛症状好转。末次随访,17例患者最终实现了骨与软组织的愈合,骨愈合率为94.4%.按照Karistrom和Olemd膝、踝关节功能评定标准,本组病例术后患肢功能恢复优良率为83.3%.结论:诱导膜技术联合骨搬运技术治疗胫骨骨髓炎并节段性骨缺损愈合效果肯定,感染控制率高,后期患肢功能恢复良好。
引文
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[13]MASQUELET A C.Induced membrane technique:pearls and pitfalls[J].J Orthop Trauma,2017,31:36-38.
[14]邱贵兴,孙世荃.同种异体骨植入材料的临床应用[J].中华骨科杂志,2004,24(10):635-637.
[15]CHADAYAMMURI V,HAKE M,MAUFFREY C.Innovative strategies for the management of long bone infection:a review of the Masquelet technique[J].Patient Saf Surg,2015,9(32):2-10.
[16]刘亦杨,沈立锋,张春,等.骨搬移技术治疗下肢长骨干艮性骨髓炎伴骨缺损术后骨性愈合不良的原因分析及对策[J].中国骨伤,2018,31(6):556-561.
[17]MARAIS LC,FERREIRA N.Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis[J].Strategies Trauma Limb Reconstr,2015,10(1):27-33.
[18]MAKHDOM A M,HAMDY R C.The role of growth factors on acceleration of bone regeneration during distraction osteogenesis[J].Tissue Eng Part B Rev,2013,19(5):442-453.
[19]XU J,JIA Y C,KANG Q L,et al.Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis[J].Injury,2015,46(10):2030-2035.
[2]OBREMSKEY W,MOLINA C,COLLINGE C,et al.Current practice in the management of open fractures among orthopedic trauma surgeons.Part B:management of segmental long bone defects.a survey of orthopaedictrauma association members[J].J Orthop Trauma,2014,28:203-207.
[3]TATUM R L.Lateral pressure and VAS pain score analysis for the lateral lumbar underbody fusion procedure[J].Into Spine Surg,2015,9:48.
[4]王亦璁,姜保国.骨与关节损伤[M].5版.北京:人民卫生出版社,2015:1353.
[5]QIN C H,ZHANG H A,CHEE Y H,et al.Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation-suction in the treatment of lower limb chronic osteomyelitis[J].Injury,2018,10:36.
[6]ZIMMERLI W,SENDI P.The role of rifampin against staphylococcal biofilm infections in vitro,in animal models,and in orthopedic device-related infections[J].Antimicrob Agents Chemother,2018,19:1-25.
[7]ZHANG H,XUE F,JUN XIAO H,et al.Ilizarov method in combination with autologous mesenchymal stem cells from iliac crest shows improved outcome in tibial nonunion[J].Saudi Journal of Biological Sciences,2018,25(4):1-21.
[8]HARA A,YOKOYAMA M,ICHIHARA S,et al.Masquelet technique for the treatment of acute osteomyelitis of the PIP joint caused by clenched-fist human bite injury:a case report[J].International Journal of Surgery Case Reports,2018,51:282-287.
[9]WALKER M,SHARAREH B,MITCHELL S A.Masquelet reconstruction for posttraumatic segmental bone defects in the forearm[J].J Hand Surg,2018,7:e1-e8.
[10]任鹏,阿不来提·阿不拉,夏依买尔旦·买买提,等.诱导膜技术结合骨搬运技术两阶段治疗胫骨创伤后骨髓炎[J].中华创伤骨科杂志,2017,19(10):880-885.
[11]薛有地,张晖,黄富国.Ilizarov骨搬运技术结合抗生素骨水泥间隔物治疗胫骨感染性不愈合[J].中华创伤骨科杂志,2014,16(7):581-585.
[12]COOK G E,MARKEL D C,REN W,et al.Infection in orthopedics[J].J Northup Trauma,2015,29:19-23.
[13]MASQUELET A C.Induced membrane technique:pearls and pitfalls[J].J Orthop Trauma,2017,31:36-38.
[14]邱贵兴,孙世荃.同种异体骨植入材料的临床应用[J].中华骨科杂志,2004,24(10):635-637.
[15]CHADAYAMMURI V,HAKE M,MAUFFREY C.Innovative strategies for the management of long bone infection:a review of the Masquelet technique[J].Patient Saf Surg,2015,9(32):2-10.
[16]刘亦杨,沈立锋,张春,等.骨搬移技术治疗下肢长骨干艮性骨髓炎伴骨缺损术后骨性愈合不良的原因分析及对策[J].中国骨伤,2018,31(6):556-561.
[17]MARAIS LC,FERREIRA N.Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis[J].Strategies Trauma Limb Reconstr,2015,10(1):27-33.
[18]MAKHDOM A M,HAMDY R C.The role of growth factors on acceleration of bone regeneration during distraction osteogenesis[J].Tissue Eng Part B Rev,2013,19(5):442-453.
[19]XU J,JIA Y C,KANG Q L,et al.Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis[J].Injury,2015,46(10):2030-2035.