成人下肢长骨骨折相关感染的治疗分析

Treatment of infection related to lower long bone fracture in adults

目的介绍成人下肢长骨骨折相关感染的治疗经验。方法回顾性分析2017年1月至2020年12月期间解放军总医院第七医学中心骨科收治的31例成人下肢长骨骨折相关感染的患者资料。其中男20例,女11例;年龄(35.7±16.7)岁;急性感染9例,延迟感染3例,迟发感染19例;分别按照感染分期采用保留或取出内置物后行清创、植骨、骨延长等治疗;术后定期复查并至少完成12个月随访,观察患者症状、体征、影像学和血化验指标变化,末次随访时记录患者Paley骨折愈合评分。结果31例患者均获随访,时间13.0(13.0,31.0)个月;9例急性感染患者中6例保留了内置物,1例因无法耐受换药、2例因感染控制不满意取出内置物;3例延迟感染患者中1例保留了内置物,2例因感染控制不满意取出内置物;19例迟发感染患者中均取出内置物清创后5例行局部植骨,6例行Masqulet技术,8例行骨搬移治疗。所有患者均获愈合,无感染复发;根据Paley骨折愈合评分标准评定疗效:优25例,良5例,可1例。结论成人下肢骨折相关感染应按临床分期采用相应的治疗方案,急性和延迟感染争取保留内置物,慢性感染取出内置物并彻底清创后行骨与软组织重建,个性化的诊疗方案可获得满意临床结果。

Objective To introduce our experience in the treatment of infection related to lower long bone fracture in adults.Methods From January 2017 to December 2020,31 adult patients with infection related to lower long bone fracture were treated at Department of Orthopaedics,the 7th Medical Center,General Hospital of the People's Liberation Army.They were 20 males and 11 females with an age of(35.7±16.7)years.There were 9 cases of acute infection,3 cases of delayed infection and 19 cases of late infection.They were treated according to their stage of infection,respectively,by retaining or removing the internal fixation,debridement,bone grafting and bone lengthening.They were followed up regularly for at least 12 months to observe their symptoms,signs,indexes of imaging and blood tests.Paley score for fracture union was recorded at the last follow-up.Results All the 31 patients were followed up for 13.0(13.0,31.0)months.Of the 9 patients with acute infection,6 retained the implant,1 removed the implant for dressing change due to intolerability and 2 removed the implant due to unsatisfactory infection control.Of the 3 patients with delayed infection,1 retained the implant and 2 removed the implant because of unsatisfactory infection control.Of the 19 patients with delayed infection,5 were treated with local bone graft,6 with Masqulet technique and 8 with bone transfer following debridement and implant removal.All patients were cured without recurrence of infection.According to Paley's scoring,25 cases were excellent,5 were good,and 1 was fair.Conclusions Treatment of infection related to lower long bone fracture in adults should be carried out according to its clinical stage.For acute and delayed infection,implants should be preserved as much as possible;for chronic infection,implants should be removed to perform bone and soft tissue reconstruction after thorough debridement.Personalized diagnosis and treatment protocols can lead to satisfactory clinical results.