| 抗生素骨水泥珠链结合外固定架治疗感染性骨折不愈合 |
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投稿时间：2008-10-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 李文毅 |
LI Wen-yi |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
zhangbosong@sina.com |
| 张伯松 |
ZHANG Bo-song |
北京积水潭医院创伤骨科 |
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| 张隆 |
ZHANG Long |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
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| 郑旺 |
ZHENG Wang |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
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| 郑淑慧 |
ZHENG Shu-hui |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
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| 戴定 |
DAI Ding |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
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| 王树茂 |
WANG Shu-mao |
河北省人民医院骨科,河北 石家庄 050051 |
Department of Orthopaedics,Hebei General Hospital,Shijiazhuang 050051,Hebei,China |
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| 期刊信息：《中国骨伤》2009年，第22卷，第2期，第90-92页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的：探讨抗生素骨水泥珠链植入结合外固定架固定治疗感染性骨折不愈合的疗效。
方法：回顾分析22例感染性骨折不愈合患者，男20例，女2例；年龄21～74岁，平均(34.7±11.6)岁。骨折部位：股骨粗隆间3例、股骨干6例、股骨髁上2例、胫骨干9例、肱骨干2例。治疗过程分为3个步骤：先取出内固定物，清创后植入抗生素骨水泥珠链，Ⅰ期闭合伤口；1周后再次清创，更换抗生素骨水泥珠链，行外固定架固定；3个月后取出抗生素骨水泥珠链，取髂骨植骨。
结果：随访15～28个月，平均(19.98±4.16)个月。1例胫骨干骨折和1例股骨粗隆间骨折患者分别于植骨术后2、3个月感染复发，其余20例患者感染控制良好。22例患者骨折全部愈合，愈合时间为植骨术后8～24周，平均(15.09±4.13)周。
结论：彻底清创、抗生素骨水泥珠链植入结合外固定架固定及Ⅱ期植骨是治疗感染性骨折不愈合简单而有效的方法。 |
| 【关键词】感染 骨折,不愈合 抗生素骨水泥珠链 外固定器 骨移植 |
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| Antibiotic-PMMA beads combined with external fixator for treating the infected fracture nonunion |
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ABSTRACT
Objective: To investigate the effects of antibiotic-PMMA(polymethyl-methacrylate) beads combined with external fixator in treatment of infected fracture nonunion.
Methods: Twenty-two cases of infected fracture-nonunions were reviewed involving 20 male and 2 female with an average age of 34.68 years(ranging 21 to 74 years). The data consisted of 9 cases of tibial fractures,2 distal fractures of the femur, 6 femoral shaft fractures,3 intertrochanteric fracture of the femur and 2 humeral shaft fractures. The procedure included thorough debridement to wipe out dead bone and granulation tissue,then antibiotic-PMMA bead chains imbedded into the dead space. One week later,secondary debridement was performed,antibiotic-PMMA bead chains were changed according to result of bacterial culture and susceptibility test,and fractures were stabilized with external fixator. Three months after debridement,antibiotic-PMMA bead chains were taken out and bone graft with autogenous iliac cancellous bone chips was performed.
Results: The mean follow-up period was 19.98 months(ranging 15 to 28 months). Infection was controlled in 20 cases. One tibial fracture and 1 intertrochanteric fracture of the femur needed repeated debridement 2 and 3 months after bone grafting respectively,because of infection recurrence and sinus formation. All 22 cases achieved bony union averaged 15.09 weeks after bone grafting with a range of 8 to 24 weeks.
Conclusion: Thorough debridement,imbedding antibiotic-PMMA bead chains combined with external fixator and staged bone grafting has proven to be effective and simple for treatment of infected fracture nonunion. The antibiotic bead delivers high tissue levels,obliterates dead space,aids bone repair. |
| KEY WORDS Infection Fractures,ununited Antibiotic-PMMA bead External fixators Bone transplantation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李文毅,张伯松,张隆,郑旺,郑淑慧,戴定,王树茂.抗生素骨水泥珠链结合外固定架治疗感染性骨折不愈合[J].中国骨伤,2009,22(2):90~92 |
| 英文格式: | LI Wen-yi,ZHANG Bo-song,ZHANG Long,ZHENG Wang,ZHENG Shu-hui,DAI Ding,WANG Shu-mao.Antibiotic-PMMA beads combined with external fixator for treating the infected fracture nonunion[J].zhongguo gu shang / China J Orthop Trauma ,2009,22(2):90~92 |
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