诱导膜在感染性骨缺损治疗中的作用观察

Observation of the effect of induced membrane in the treatment of infective bone defects

目的探讨诱导膜在感染性骨缺损治疗中的作用。方法 2008年1月~2015年9月,应用万古霉素骨水泥填塞、二期植骨治疗感染性骨缺损38例。分为诱导膜包裹组(A组,24例)和无诱导膜包裹组(B组,14例)。记录骨愈合、感染复发和再次手术干预情况,骨愈合和邻近关节功能分级按Paley方法分别评价。结果随访12~51(平均19.6)个月。A组均一期愈合,临床愈合时间3.0~7.0(平均5.25)个月;B组1例骨不愈合,B组临床愈合时间3.0~15.0(平均6.64)个月。A组术后感染复发1例,B组感染复发3例。B组需要再次手术干预3例,A组无。两组的骨愈合时间和再次手术干预率比较,差异有统计学意义(P<0.05),虽然两组感染复发率比较差异无统计学意义(P>0.05),但B组感染复发率呈高于A组的趋势。末次随访,两组的骨缺损愈合分级和邻近关节功能恢复比较,差异无统计学意义(P>0.05)。结论诱导膜完整性与骨愈合效果有关,负载抗生素骨水泥填塞形成的诱导膜对感染性骨缺损术后感染复发具有一定的隔离保护作用。

Objective To investigate the effect of induced membrane in the treatment of infective bone defects. Methods From January 2008 to December 2015, 38 patients with infective bone defects were treated with vancomycin bone cement packing and staged bone grafting. They were divided into encapsulation group with induced membrane（group A, 24 cases） and no-encapsulation group（group B, 14 cases）.Bone healing, recurrence of infection and intervention of resurgery were recorded, grade of bone healing and adjacent joint functional recovery were evaluated according to Paley method, respectively. Results All patients were followed up for 12 to 51 months, with an average of 19.6 months. In group A, all healed by first intention, the clinical healing time was 3.0～7.0 months, with an average of 5.2 months; in group B, 1 case had bone nonunion, and the clinical healing time was 3.0～15.0 months, with an average of 6.64 months. 1 case with recurrence of infection was noted in group A whereas 3 cases were noted in group B. 3 cases required intervention of resurgery in group B whereas no case was noted in group A. The clinical healing time and intervention rate of resurgery were statistically different （P〈0.05）; a trend of higher recurrence rate in group B than in group A was noted although there was no significant difference between the two groups （P〉0.05）. At the last follow-up, there was no significant difference between the two groups in the grade of bone defect healing and the functional recovery of the adjacent joint （P〉0.05）. Conclusion The integrity of the induced membrane is related to bone healing, and the induced membrane formed after packing of antibiotic bone cement has a protective effect on the recurrence of infection.