抗生素骨水泥涂层髓内钉结合Masquelet技术治疗胫骨干感染性骨缺损

Antibiotic bone cement coated intramedullary nail combined with Masquelet technique in treatment of infectious bone defect of tibia shaft

目的探讨抗生素骨水泥涂层髓内钉结合Masquelet技术治疗胫骨干感染性骨缺损的疗效。方法选取2017年5月至2019年1月我院收治的28例胫骨干感染性骨不连患者。所有患者采用Masquelet技术分两个阶段进行治疗第一阶段手术行骨折端清创控制感染,随后以抗生素骨水泥涂层髓内钉固定骨折,骨缺损处予以骨水泥占位;第二阶段手术取出骨折端占位器,给予诱导膜内植入自体髂骨。所有患者在第二阶段手术后均进行12~28个月的随访,平均(18.6±5.2)个月。记录患肢术后并发症、骨愈合时间及功能情况,并采用Johner-Wruhs关节功能评定标准评估手术疗效。结果第一阶段手术后,所有患者CRP、ESR和IL-6等炎性指标水平均处于正常状态,2例患者出现切口皮缘部分坏死,经换药处理后均愈合。在第二阶段手术结束后,26例(92.86%)患者各项指标正常,未发现窦道或感染复发,骨折均愈合,愈合时间3~7个月,平均4.6个月;另外2例(7.14%)患者在手术后出现感染复发,临床症状表现为胫骨手术部位出现窦道且伴有脓液,经二次清创及Masquelet技术治疗后感染治愈并实现骨折愈合。根据Johner-Wruhs关节功能评定标准优16例,良8例,中2例,差2例,优良率为85.71%。结论抗生素骨水泥涂层髓内钉结合Masquelet技术可以有效解决胫骨干慢性骨髓炎清创后骨缺损问题,可显著缩短治疗周期,手术操作简单,术后并发症少,患肢功能恢复良好,疗效满意。

Objective To investigate the effect of antibiotic bone cement coated intramedullary nail combined with Masquelet technique in the treatment of infectious bone defect of tibia shaft.Methods From May 2017 to January 2019,28 patients with infectious nonunion of tibia shaft in our hospital were enrolled.All the patients were treated by Masquelet technique in two stages.In the first stage,the fracture was debrided to control infection,and then the fracture was fixed with antibiotic bone cement coated intramedullary nail,and the bone cement was used to occupy the bone defect.In the second stage,the fracture end placeholder was removed and the autologous iliac bone was implanted in the induced membrane.All the patients were followed up for 12 to 28 months after the second stage,with an average of(18.6±5.2)months.The postoperative complications,bone healing time and function of the affected limb were recorded.The operative effect was evaluated by the Johner-Wruhs joint function evaluation standard.Results After the first stage,the inflammatory indicators such as CRP,ESR and IL-6 were in normal state.Two patients had partial necrosis of the incisional skin margin and they all healed smoothly after dressing change.After the second stage,26 patients(92.86%)had normal indicators.All the fractures healed with no recurrence of sinus or infection.The healing time was 3 to 7 months,with an average of 4.6 months.The other 2 patients(7.14%)had recurrence of infection after surgery.The clinical symptoms were sinus and pus at the tibial surgical site.After the second debridement and Masquelet technique treatment,the infection was cured and the fracture healing was achieved.According to the Johner-Wruhs joint function evaluation standard,16 cases were excellent,8 cases were satisfactory,2 cases were medium,and 2 cases were poor,the satisfactory rate was 85.71%.Conclusion Antibiotic bone cement coated intramedullary nail combined with Masquelet technique can effectively solve the problem of bone defect after debridement of tibial shaft chronic osteomyelitis,which can significantly shorten the treatment period with simple operation,fewer postoperative complications,good functional recovery of the affected limb,and satisfactory curative effect.