外固定架联合抗感染重组合异种骨治疗胫骨干感染性骨不连

Efficacy of anti-infective reconstituted bone xenograft combined with external fixation on adult infective nonunion of humeral shaft

目的探讨抗感染重组合异种骨(ARBX)植骨联合外固定架治疗成人胫骨干感染性骨不连的疗效。方法采用回顾性病例系列研究分析2014年1月—2016年12月空军军医大学西京医院收治的18例胫骨干感染性骨不连患者临床资料,其中男10例,女8例;年龄19~62岁[(36.9±11.8)岁]。感染性骨不连根据Umiarov分型:Ⅲ型11例,Ⅳ型7例。均采用外固定架联合ARBXⅠ期植骨治疗。记录手术次数、骨性愈合时间、骨性愈合率、感染控制率、术后负重时间、外固定架拆除时间、术后并发症。检测术前术后红细胞沉降率(ESR)及C-反应蛋白(CRP)水平。采用Johner-Wruhs下肢功能评分对骨折愈合和功能恢复情况进行评价。结果患者均获随访12~30个月[(21.3±5.6)个月]。手术次数为(1.4±0.9)次,骨性愈合时间为(16.6±5.8)个月,骨性愈合率为83%(15/18),感染控制率为94%(17/18)。15例获骨性愈合患者的术后负重时间为(3.3±1.5)个月,外固定架拆除时间为(18.5±4.2)个月。术后再次骨不连3例,其中感染复发1例;钉道感染5例。术后3个月ESR[(13.1±8.4)mm/h]和CRP[(5.6±4.6)mg/L]较术前[(47.3±19.2)mm/h、(23.4±7.4)mg/L]显著降低(P<0.05)。根据Johner-Wruhs下肢功能评分:优9例,良4例,中1例,差4例,优良率为72%。结论外固定架联合ARBX植骨可有效治疗感染性胫骨干骨不连,并提高骨愈合率,促进患者功能恢复。

Objective To investigate the efficacy of anti-infective reconstituted bone xenograft(ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients withinfected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical Universityfrom January 2014 to December 2016. There were 10 males and eight females, aged 19-62 years [ (36. 9 ±11.8) years ]. According to Uniiarov classification of infective nonunion, there were 11 patients with typeIII and seven with type IV. All patients were treated with anti-infective reconstituted bone xenograft(ARBX) combined with external fixation. The number of operations, bone healing time, bone healingrate, infection control rate, postoperative weight bearing time, the time of external fixation removal,postoperative complications, erythrocyte sedimentation rate ( ESR) , and C-reactive protein ( CRP) beforeand after operation were recorded. Fracture healing and functional recovery were evaluated using theJohner-Wruch lower limb function score. Results The patients were followed up for 12-30 months[(21.3 ±5.6)months]. The operation was performed for ( 1.4 ±0. 9) times, with time of bone healingfor ( 16. 6 ±5. 8) months, bone healing rate of 83% (15/18), and infection control rate of 94% (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was ( 3. 3 ± 1.5 ) monthsafter operation, and the external fixation removal time was (18.5 ±4.2) months after operation. Therewere three patients with nonunion after operation including one with infection recurrence. Five patientswere found with nail tract infection. ESR and CRP at postoperative 3 months [ ( 13. 1 ±8.4) nim/h and(5.6 ±4. 6 ) mg/I. were significantly lower than those before operation ( 47. 3 ± 19. 2 ) mm/h and(23. 4 ±7. 4) mg/1. ( P < 0. 05 ). According to Johner-Wruch lower limb function scores, the resultswere excellent in nine patients, good in four, fair in one, and poor in four, with excellent and good rate of72%. Conclusion ARBX combined with External fixation can effectively treat infective nonunion ofhumeral shaft, improve bone healing rate, and promote function recovery.