快捷式抗感染占位器结合膜诱导技术治疗感染性骨缺损

Quick antiinfective spacer combined with Masquelet technique for treatment of infectious bone defects

目的探讨快捷式抗感染占位器结合膜诱导技术治疗感染性骨缺损的疗效。方法回顾性分析2006年1月至2013年6月期间收治的52例感染性骨缺损患者资料，男46例，女6例；年龄为19—46岁，平均31．3岁。骨缺损长度为2．5—6．5cm，平均3．1cm。实施序贯性治疗方案：第1阶段行清创及抗感染治疗，术中制备个体化快捷式抗感染占位器（抗生素与骨水泥粉末混合后再加入聚甲基丙烯酸甲酯单体）；第2阶段采用膜诱导技术修复骨缺损及骨缺损处行内固定。结果52例患者术后获13～28个月（平均21个月）随访。所有患者感染性骨缺损均治愈，X线片示植骨区骨密度较术前明显增高，颗粒骨吸收并有新骨形成。52例患者均获骨性愈合，愈合时间为6—10个月，平均7．5个月，无感染复发和畸形发生。结论快捷式抗感染占位器能够在骨缺损早期通过局部释放持续、有效、高浓度的抗生素来控制局部感染，同时维持肢体长度和增加断端稳定性，减少骨及软组织挛缩，为后期修复创造条件；其结合膜诱导技术可提高感染性骨缺损的早期救治效果。

Objective To investigate the efficacy of quick antiinfective spacer combined with Masquelet technique in the treatment of infectious bone defects. Methods From January 2006 to June 2013, we treated 52 patients with infectious bone defects. They were 46 men and 6 women, aged from 19 to 46 years （average, 31.3 years）. They were treated by debridement and anti-infection therapy at the first stage when the individualized quick antiinfective spacers were prepared （a mixture of antibiotics and bone cement powder added by polymethyl methacrylate morphon） . At the second stage, the bone defects were repaired using Masquelet technique before they were internally fixated. Results The 52 patients were followed up for an average time of 21 months （range, from 13 to 28 months）. All the infectious bone defects were healed. X-ray examination showed that the bone mineral density at the bone grafting area increased significantly compared with pre-operation, suggesting granular bone resorption and new bone formation. All the fractures obtained bony union after 6 to 10 months （average, 7.5 months）, without recurrence of infection or teratogenesis. Conclusions Quick antiinfective spacer can control local infection in the early period of bone defect by sustainable local release of effective antibiotics of high concentrations while it maintains limb length, increases the stability of fracture ends, and reduces contracture of bone and soft tissue. All these roles may create favorable conditions for late repair, reduce the infection rate and improve the efficacy of early management.