深筋膜下非接触钢板治疗隐匿感染性股骨再骨折

Treatment of femur re-fracture with occult infection by using non-contact locking plate under deep fascia

目的探讨深筋膜下非接触锁定钢板治疗股骨骨折术后隐匿感染性再骨折的疗效。方法回顾分析2010年1月—2014年12月收治的12例股骨骨折术后隐匿感染性再骨折患者临床资料。其中男8例,女4例;年龄28~69岁,平均42.8岁。内固定物取出后3 d^4周(平均10.6 d)再骨折5例,其中钢板固定4例、髓内钉固定1例;内固定术后7~16个月(平均9.3个月)内固定物断裂并骨折7例,其中钢板断裂5例,髓内钉断裂2例。术中常规行细菌培养,切取组织送病理检查,采用断端清创、深筋膜下非接触锁定钢板固定、松质骨颗粒移植治疗。术后应用抗生素药物静脉滴注2~3周,口服4周。术后定期复查X线片,根据美国特种外科医院(HSS)膝关节评分系统评定膝关节功能。结果术后细菌培养阳性8例,阴性4例,病理检查证实均为慢性骨感染。所有患者伤口未出现渗液、破溃等现象。12例患者均获随访,随访时间18~36个月,平均29.6个月。骨折愈合良好,未再发生骨折,骨折临床愈合时间为14~22周,平均18周。末次随访时根据HSS膝关节评分系统评定患侧膝关节功能:优9例,良3例。结论股骨骨折术后再骨折的治疗需判断是否存在隐匿性感染,深筋膜下非接触锁定钢板固定是治疗隐匿感染性股骨再骨折的有效方法。

Objective To investigate the effectiveness on the re-fracture of the femur with occult infection by using non-contact locking plate which was placed under the deep fascia. Methods Clinical data of 12 cases of occult infective re-fracture after femoral fracture operation were retrospectively analysed between January 2010 and December 2014. There were 8 males and 4 females with an age of 28-69 years（mean, 42.8 years）. Femur re-fractured in 5 cases after 3 days to 4 weeks（mean, 10.6 days） of removal of internal fixation, including 4 cases of plate fixation and 1 case of intramedullary nail fixation; femur in 7 cases re-fractured because of breakage of internal fixator after 7-16 months（mean,9.3 months） of internal fixation, including 5 cases of plate fixation and 2 cases of intramedullary nail fixation. The tissues near the fracture were collected for bacteria culturing and pathological examining. All the patients were treated by debriding the site of the fracture, bridging with the non-contact locking plate, and transplanting with granulated cancellous bone autograft. Intravenous infusion of antibiotics were used for 2-3 weeks after operation and oral administration for 4 weeks. The X-ray films were taken regularly and the function of the knees were evaluated by the Hospital for Special Surgery（HSS） score system. Results The results of bacteria culturing were positive in 8 patients and negative in 4 patients, and the pathological results of all the patients were confirmed to be chronic bone infection. All the fractures healed with no signs of exudation and ulceration of the incisions. The 12 patients were followed up 18-36 months（mean, 29.6 months）. The fracture healed well and no re-fracture occurred. The fracture healing time was 14-22 weeks（mean,18 weeks）. At last follow-up, the function of the knee joint was excellent in 9 cases and good in 3 cases according to HSS score system. Conclusion The treatment of re-fractures after femur fracture operation needs to determine whether there is an occult infection, and non-contact locking plate placed under the deep fascia is an effective way for the re-fracture.