骨搬移术中植入硫酸钙对促进对合端愈合的效果观察

Effect of calcium sulfate on promoting natural healing of docking sites during bone transport

目的:探讨骨搬移术中植入硫酸钙能否促进对合端自然愈合的临床疗效。方法:回顾性分析2013年1月至2018年1月采用骨搬移和硫酸钙植入治疗的27例创伤性慢性骨髓炎患者,其中男23例,女4例;年龄20~61(44.30±10.00)岁;病程3~86(13.26±16.47)个月;骨折内固定术后创伤性慢性骨髓炎16例,开放性骨折创伤性慢性骨髓炎11例。清创后骨缺损长度4~14(9.11±2.57)cm。观察术后并发症、对合端自然愈合率、外固定指数,采用Checketts&Otterburn针道感染分级标准评价针道感染情况,并采用Paley评价标准观察骨性结果和功能结果。结果:所有患者获得随访,时间26~41(31.32±3.37)个月。27例患者均未发生对合端皮肤嵌顿,术后(17.78±5.43)个月后获得骨性愈合,其中25例对合端自然愈合,2例未自然愈合患者(均依从性较差)经对合端清理植骨后愈合,发生马蹄足畸形1例,无感染复发或再骨折病例。按照Checketts&Otterburn针道感染分级标准,共有22例(41处)发生不同程度的针道感染。外固定指数1.6~2.4(2.02±0.24)月/cm。根据Paley评价标准,骨性结果:优21例,良5例,中1例;功能结果:优19例,良7例,中1例。结论:骨搬移术中,骨缺损区植入硫酸钙能够预防骨残端之间皮肤嵌顿,有利于对合端的自然愈合,可避免大多数病例对合端Ⅱ期清理植骨,但需要注意提高骨搬移手术患者的依从性。

Objective:To observe clinical effect of calcium sulfate on promoting natural healing of docking sites during bone transport.Methods:A retrospective study was performed on the patients with posttraumatic chronic osteomyelitis treated by bone transport and calcium sulfate implantation from January 2013 to January 2018.There were 23 males and 4 females,aged from 20 to 61 years old with an average of(44.30±10.00)years,the courses of disease ranged from 3 to 86 months with an average of(13.26±16.47)months.Sixteen patients with posttraumatic chronic osteomyelitis were caused by internal fixation of closed fractures,and 11 patients were caused by open fractures.The length of bone defects after debridement ranged from 4 to 14 cm with an average of(9.11±2.57)cm.Postoperative complications,natural healing rate of the docking sites,external fixation index were observed,Checketts&Otterburn pin-tract infection classification was used to evaluate pin-tract infection,and Paley evaluation criteria was used to evaluate bone and function results.Results:Twenty-seven patients were followed up from 26 to 41 months with an average of(31.32±3.37)months.It did not happened skin embedded between bone stumps in all patients.All patients obtained bone union at(17.78±5.43)months after operation.Among them,25 patients healed naturally in the docking sites,2 patients with poor compliance healed after debridement and bone grafting in the docking sites.One patient occurred equines deformity,and no re-fracture or recurrence of infection occurred.According to Checketts&Otterburn pin tract infection classification,22 patients(41 pin tracts)occurred pin-tract infection with varying degrees.The average external fixation index was(2.02±0.24)months/cm(ranged from 1.6 to 2.4 months/cm).According to Paley evaluation criteria,bony results showed 21 patients obtained excellent results,5 good,and 1 moderate;functional results showed 19 patients got excellent results,7 good,and 1 moderate.Conclusion:During bone transport,the implantation of calcium sulfate on the bone defect areas could prevent skin embedding between the bone stumps,benefit for the natural healing of the docking sites,and could avoid the second-stage debridement and bone grafting for most patients.However,it should be noted that compliance needs to be increased.