膜诱导技术治疗Cierny-MaderⅣ型股骨慢性骨髓炎

Membrane induction technique for Cierny-Mader type IV chronic osteomyelitis of the femur

[目的]探讨膜诱导技术治疗Cierny-MaderⅣ型股骨慢性骨髓炎的临床疗效。[方法]2016年1月—2019年12月,对42例Ⅳ型股骨骨髓炎患者行两阶段手术,第一阶段彻底清创后采用膜诱导技术结合内固定治疗,第二阶段手术植骨并调整内固定,观察围手术期、随访及影像资料。[结果]一期手术后骨缺损长度5~16 cm,平均(8.24±1.16)cm,一期手术时伤口均闭合。两期手术间隔6~16周,平均(9.21±1.83)周,二期手术后伤口均闭合。平均随访时间(24.71±3.13)个月,随时间推移,髋、膝伸屈活动度、Harris和HSS评分均显著增加(P<0.05),Paley骨缺损愈合评级显著改善(P<0.05)。末次随访时,所有患者均获得影像骨折缺损愈合,愈合时间为6~16个月。[结论]彻底清创后采用膜诱导技术结合内固定治疗Cierny-MaderⅣ型股骨慢性骨髓炎能够有效控制感染,达至骨缺损愈合。

[Objective]To investigate the clinical efficacy of membrane induction technique in the treatment of Cierny-Mader type IV chronic osteomyelitis of the femur.[Methods]From January 2016 to December 2019,42 patients with Cierny-Mader type IV osteomyelitis of the femur were treated with two stages of surgery.In the first stage a thorough debridement followed by antibiotic bone cement filling combined with internal fixation were conducted,while in the second stage bone grafting and internal fixation adjustment were performed secondary to bone cement removal.The documents regarding to clinical setting and imaging were observed.[Results]The length of bone defect ranged from 5 to 16 cm with an average of(8.24±1.16)cm after the thorough debridement in the first stage with well wound closure.The interval between the two stages of surgery was 6~16 weeks,with an average of(9.21±1.83)weeks,and the incision healed well after the second stage of surgery.As time went during the follow-up time lasted for(24.71±3.13)months,the range of motions(ROMs)of both hip and knee,as well as Harris and HSS scores significantly increased(P<0.05),and Paley grade for bone defect healing significantly improved(P<0.05).At the latest follow-up,all patients achieved radiographic fracture healing with healing time ranging from 6 to 16 months.[Conclusion]This membrane induction technique combined with internal fixation is an effective treatment for Cierny-Mader type IV chronic osteomyelitis of the femur with a benefit of high-efficient control of infection to achieve bone healing.