改良髂骨移植结合抗生素骨水泥技术治疗合并大段骨缺损指骨骨感染疗效分析

Modified iliac bone transplantation combined with antibiotics bone cement technology in the treatment of phalangeal bone infection with large bone defect

目的分析改良髂骨移植结合抗生素骨水泥技术治疗合并大段骨缺损指骨骨感染的临床疗效。方法回顾性分析2015年3月-2019年12月收治的7例合并大段骨缺损指骨骨感染患者的临床资料,通过改良髂骨移植结合抗生素骨水泥技术进行治疗。第一阶段行坏死感染骨的彻底清除,并放置抗生素骨水泥棒假体形成膜诱导;第二阶段在诱导膜内植入张力髂骨段及米粒松质骨块联合植骨行牢靠固定,可在术后早期去除内固定并行手功能康复训练。结果术后7例均获得门诊随访,随访时间6~12个月,平均(9±1.5)个月。第一阶段手术部伤口6例一期愈合,1例经再次扩创后二期愈合,第二阶段手术手部伤口均一期愈合。7例髂骨供区伤口均一期愈合,无股前外侧皮神经损伤。7例第二阶段手术后均定期复查X线片,无明显髂骨段植骨吸收,去除内固定时间为术后6~8周,平均(7±0.5)周,骨折愈合时间为术后8~12周,平均(10±0.5)周。末次随访均采用中华医学会手外科学会上肢功能关于手功能评定试用标准进行评价:优3例,良2例,可2例,优良率71.4%。结论改良髂骨移植联合抗生素骨水泥技术治疗合并大段骨缺损的指骨骨感染,可提高植骨后骨架支撑的稳定性,缩短移植骨的爬行替代过程和固定周期,为更好的手功能恢复提供有利条件。

Objective To analyze the clinical effect of modified iliac bone transplantation combined with antibiotical bone cement technology on the treatment of phalangeal bone infection with large bone defect.Methods Were retrospectively analyzed 7 cases of patients of phalangeal bone infection complicated by large bone defect treated iliac bone transplantation combined with antibiotical bone cement technology from March 2015 to December 2019.First phase,thoroughly removed necrotic and infected bone,and placed the antibiotical bone cement rod prosthesis to form induced membrane;The second phase,in the induced membrane implanted tension iliac bone block section and rice cancellous bone graft,fixed reliably and in the early postoperative stage,removed internal fixation carried out hand functional rehabilitation exercise.Results All 7 cases were followed up for 6 to 12 months,an average of(9±1.5)months;In the first phase,6 cases obtained primary healing wounds in the department of surgery,1 case obtained secondary healing after debridement again,in the second stage,the hand wounds had primary healing.7 cases of iliac crest wound had primary healing,without femoral anterolateral skin nerve damage.7 cases of the second stage after the operation had periodic review of X-ray,no obvious iliac crest bone graft absorption occurred,removed internal fixation for 6 to 8 weeks postoperatively,an average of(7±0.5)weeks,fracture healing time was 8 to 12 weeks after surgery,with the average of(10±0.5)weeks.In the last follow-up,according to the Chinese medical association of hand function of upper limb function the probation evaluation standard,excellent in 3 cases,good in 2 cases,fair in 2 cases;the excellent and good rate was 71.4%.Conclusion Treatment with antibioticd bone cement technology combined with modified iliac bone transplantation for phalengeal bone infection with bone defect.The improved method of implanting tension iliac bone segment can stable the skeleton support,shorten the crawling replacement process and fixation time.It can provide favorable conditions for better hand function rehabilitation.