Ⅰ期开放松质骨植骨治疗感染性骨缺损

Treatment of infected bone defect with one stage open cancellous bone grafting

目的:探讨Ⅰ期开放松质骨植骨治疗感染性骨缺损的可行性,总结提高治疗成功率的因素。方法:12例感染性骨缺损患者,男8例,女4例;年龄22～68岁,平均42岁。其中跟骨骨缺损7例,胫骨4例,股骨1例。采用患处换药,刮除失活的软组织及骨组织,清创后Ⅰ期行自体松质骨植骨,伤口开放,术后创面爬满肉芽后行游离植皮治疗。结果:术后移植骨质表面覆盖肉芽组织时间平均24.1d,创面完全闭合时间平均30.3d,所有患者经过8～30个月(平均18个月)随访,所有骨缺损处经植骨后均骨性愈合,未发现感染复发者。结论:Ⅰ期开放植骨术是治疗感染性骨缺损简单可行的方法,术前刮除失活组织,术中彻底清除肉芽组织、充分植入松质骨及术后严格无菌换药是手术成功的关键。

Objective：To explore the feasibility of the treatment of infected bone defect with one stage open cancellous bone grafting and summarize the key factors improving the curative effects. Methods：Twelve cases of infected bone defects were reviewed, which involved 8 male and 4 female with an average age of 42 years （range, 22 to 68 years）. The study consisted of 7 cases of calcaneal defects ,4 tibial defects and 1 femoral defect. The procedure included dressing change, resection of the devitalized soft tissue and bone tissue. After the debridement, the bone defect at one stage was treated with cancellous bone grafting and the wound was open. The wound was closed with skin transplantation when it was covered by granulation tissue completely. Results ：The wound was covered with granulation tissue in the average 24.1 days after operation and was closed in the average 30.3 days. All the patients were followed up for 8 to 30 months with an average time of 18 months. All the bone defects were healing after bone grafting and there was no infection recurrence. Conclusion ：One stage open cancellous bone graft is an easy and feasible treatment for infected bone defect. Resecting of the devitalized tissue before operation ,radical debridement ,enough bone graft in operation and careful dressing change after operation are all the key factors to acquire the satisfactory outcome.