病灶扩大切除结合膜诱导技术治疗成人下肢感染性骨缺损的影响因素分析

Analysis of Influential Factors in the Treatment of Infective Bone Defect in Adult Lower Extremities by Expanded Lesion Resection Combined with Membrane Induction

目的:分析病灶扩大切除结合膜诱导技术治疗成人下肢感染性骨缺损的影响因素.方法:回顾性分析2016年5月—2022年3月我院治疗的40例下肢长骨干感染性骨缺损患者的临床资料,患者入院后均接受病灶扩大切除结合膜诱导技术方案,详细记录两个阶段手术治疗结果,分析影响患者骨愈合时间和下肢功能改善的相关因素.结果:随访术后1年临床疗效显著,术后感染未再复发,患者术后1年的C反应蛋白、红细胞沉淀率、白细胞计数均低于术前,健康状况调查简表评分和下肢功能评价量表(LEFS)评分均高于术前,组间差异有统计学意义(P<0.05).患者术后骨愈合时间与患者年龄、病灶部位相关,年龄越大患者骨愈合速度越慢,股骨愈合速度快于胫骨,组间差异有统计学意义(P<0.05);与患者C-M分型、植骨类型、间断期时间、一阶段术中固定方式及病因无较大关联性(P>0.05);患者术后下肢功能改善情况(LEFS评分)与其一阶段术中固定方式相关,内固定更有利于患者下肢功能改善(P<0.05);与其他因素无较大关联性(P>0.05).结论:下肢长骨干感染性骨缺损患者接受病灶扩大切除结合膜诱导技术治疗疗效显著,对于控制感染率有较好的效果,而影响患者术后骨愈合的因素主要为年龄和病灶部位,除此之外,一阶段术中固定方式选择内固定更有利于患者下肢功能改善.

Objective:To analyze the influencing factors of extended resection combined with induced membrane technique in the treatment of adult lower extremity infected bone defects.Methods:The clinical data of 40 patients with infectious bone defects of lower limb long bone treated in our hospital from May 2016 to March 2022 were retrospectively analyzed.All patients received extensive resection of the lesion combined with membrane induction technique after admission.The results of the two stages of surgical treatment were recorded in detail,and the related factors affecting the bone healing time and the improvement of lower limb function were analyzed.Results:The C-reactive protein,erythrocyte sedimentation rate,and white blood cell count of the patients 1 year after operation were lower than those before operation,and the scores of the short form health survey and the lower extremity Functional Evaluation scale(LEFS)were higher than those before operation,and the differences were statistically significant(P<0.05).The bone healing time was related to the age of the patients and the location of the lesion.The bone healing speed was slower in the older patients,and the healing speed of the femur was faster than that of the tibia,and the differences were statistically significant(P<0.05).There was no significant correlation with C-M classification,bone graft type,interval time,one-stage fixation method and etiology(P>0.05).The postoperative improvement of lower limb function(LEFS score)was related to the method of intraoperative fixation at the first stage,and internal fixation was more conducive to the improvement of lower limb function(P<0.05).There was no significant correlation with other factors(P>0.05).Conclusion:Extensive resection of the lesion combined with induction membrane technique is effective in the treatment of infectious bone defects in the long bone of the lower extremity,which has a good effect on the control of infection.The main factors affecting bone healing are age and lesion site.