膜诱导技术结合内固定治疗胫骨感染性骨不连

Effect of induced membrane technique combined with internal fixation for treatment of infection nonunion of tibia

目的探讨膜诱导技术结合内固定治疗胫骨感染性骨不连患者的疗效。方法回顾性分析2016年1月至2016年12月陆军军医大学西南医院骨科收治的21例胫骨感染性骨不连患者的临床资料。其中,男15例,女6例;平均年龄41(22~58)岁。所有患者均采用膜诱导技术结合内固定治疗。手术分两期进行:一期彻底清创,抗生素骨水泥填塞,钢板内固定;6~8周感染控制后行诱导膜内植骨重建骨缺损,同时更换内固定。记录随访期间患者的骨愈合时间及并发症发生情况。结果平均随访27(24~30)个月。所有患者均获得影像学及临床愈合,影像学愈合时间平均为4.5(4~6)个月,临床愈合时间平均为6(5~8)个月。随访期间有1例患者出现一期清创后感染复发,经过再次清创感染控制后二期重建达到骨愈合。末次随访时,患者下肢功能量表(LEFS)评分平均为70(59~80)分。结论膜诱导技术结合内固定治疗胫骨感染性骨不连患者的临床疗效显著,具有感染复发率低、骨愈合快、愈合率高、功能恢复好等优势。

Objective To investigate the clinical effect of induced membrane technique combined with internal fixation for treatment of infection nonunion of tibia.Methods The clinical data of 21 patients with infection nonunion of tibia in Department of Orthopedics,Southwest Hospital,Army Medical University were retrospectively analyzed from January 2016 to December 2016.All patients were treated with induced membrane technique combined with internal fixation.There were 15 males and 6 females aged 22-58 years(mean,41 years).Surgical treatments were performed including phase I surgical debridement,antibiotics-loaded bone cement impregnation to induce a membrane,and internal fixation and phaseⅡbone defect reconstruction by intramembranous bone grafting and replacement of internal fixation.The bone healing time,complications were recorded during follow-up time.Results The follow-up time was 24-30 months(mean,27 months).All patients obtained imaging and clinical healing,the healing time were 4-6 months(mean,4.5 months)and 5-8 months(mean,6 months)respectively.One patient presented recurrence of infection after primary debridement,and achieved infection control after re-debridement and bone healing after reconstruction.The lower extremity functional scale(LEFS)of the last follow-up was 59-80 points(mean,70 points).Conclusion Induced membrane technique combined with internal fixation for the treatment of infection tibial nonunion has significant clinical efficacy with low infection recurrence rate,rapid bone healing,high healing rate and good functional recovery.