抗感染重组合异种骨联合外固定架治疗下肢长骨创伤后骨感染

Anti-infective reconstituted bone xenograft combined with external flxator for treatment of posttraumatic long bone infection in lower extremities

目的观察抗感染重组合异种骨（ARBX）植骨联合外固定架治疗成人下肢长骨创伤后骨感染的长期疗效。方法采用回顾性病例系列研究分析2004年1月-2013年12月应用ARBXⅠ期植骨联合环式外固定架治疗下肢长骨骨感染并获得18个月以上长期系统随访的36例患者，其中男21例，女15例；年龄19-72岁，平均35．8岁。其中多发骨折24例，单发骨折12例。采用Ilizarov方法研究与应用学会（ASAMI）分类标准评价骨修复和功能恢复情况。结果患者均获随访，时间18-72个月，平均38个月。36例患者中33例骨折愈合，感染完全治愈无复发，骨折平均愈合时间5．2个月。所有患者肢体长度均达到预期延长长度，骨延长长度3—10cm，平均5．2cm，延长区均骨性愈合。根据ASAMI标准，骨修复优20例，良13例，中3例，优良率92％；患肢功能恢复优18例，良11例，中7例，优良率81％。结论ARBX辅助外固定架Ⅰ期植骨治疗骨感染可提高骨修复率和肢体功能恢复率，Ⅰ期显著缩短植骨愈合时间。

Objective To observe the long-term efficacy of anti-infective reconstituted bone xenograft （ARBX） combined with external fixation of posttraumatic long bone infection in lower extremities. Methods This retrospective case series study included 36 patients with posttraumatic long bone infection in lower extremities followed up for more than 18 months after receiving one-stage ARBX bone grafting combined with ring external fixation from January 2004 to December 2013. There were 21 male and 15 female patients, at the age of 19-72 years （mean, 35.8 years）. Multiple fractures were seen in 24 patients and single fractures in 12 patients. Bone and functional results were evaluated using the association for the study and application of the method of Ilizarov （ASAMI） classification. Results Follow-up ranged from 18 to 72 months （mean, 38 months）. Bone union was seen in 33 cases in a mean period of 5.2 months, and infection was completely cured. Length of limbs in all patients reached the expected extension length with the bone extension length of 3-10 cm （ mean, 5.2 cm）. All the extended areas showed bone healing. According to the ASAMI classification, bone result was excellent in 20 patients, good in 13 and fair in 3, with the excellent and good rate of 92%, and limb function recovery was excellent in 18 patients, good in 11 and fair in 7, with the excellent and good rate of 81%. Conclusion ARBX adjuvant external fixator treatment of posttranmatic long bone infection in lower extremities improves bone healing rate and limb function recovery rate and shortens bone healing time at one stage.