| 抗生素骨水泥联合外固定支架在下肢开放性骨折骨缺损中的早期应用 |
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投稿时间：2016-06-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 肖坚 |
XIAO Jian |
江山市人民医院, 浙江 江山 324100 |
Jiangshan People's Hospital, Jiangshan 324100, Zhejiang, China |
23738921@qq.com |
| 毛兆光 |
MAO Zhao-guang |
江山市人民医院, 浙江 江山 324100 |
Jiangshan People's Hospital, Jiangshan 324100, Zhejiang, China |
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| 朱慧华 |
ZHU Hui-hua |
江山市人民医院, 浙江 江山 324100 |
Jiangshan People's Hospital, Jiangshan 324100, Zhejiang, China |
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| 郭亮 |
GUO Liang |
江山市人民医院, 浙江 江山 324100 |
Jiangshan People's Hospital, Jiangshan 324100, Zhejiang, China |
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| 期刊信息：《中国骨伤》2017年，第30卷，第3期，第270-273页 |
| DOI：10.3969/j.issn.1003-0034.2017.03.017 |
| 基金项目: |
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中文摘要:
目的：探讨抗生素骨水泥联合外固定支架在下肢开放性骨折伴骨缺损中早期应用的临床疗效。
方法：2013年12月至2015年1月，采用万古霉素抗生素骨水泥联合外固定支架对36例下肢开放性粉碎性骨折伴骨缺损患者进行治疗，男26例，女10例；年龄19～65岁，平均38岁。所选病例均为下肢开放性粉碎性骨折伴骨缺损，不同程度软组织损伤。其中，25例为胫骨骨折，11例股骨骨折。X线提示骨缺损，骨缺损范围为3.0～6.1 cm，平均4.0 cm.按开放性骨折Gustilo分型：ⅢA型24例，ⅢB型12例。观察创口感染率、植骨时间、骨折愈合时间及术后下肢功能。骨折临床愈合后1个月患肢功能参照Paley标准进行功能评价。
结果：36例患者获得随访，时间3～24个月，平均（6.0±3.0）个月，术后创面愈合良好，未发现骨感染及骨缺损不愈合等情况。患者使用抗生素骨水泥早期治疗后再次手术植骨时间为6周，部分延后到8周，到骨折基本愈合，疗程为4～8个月，平均（5.5±1.5）个月。根据Paley等骨与功能分级评价功能，优25例，良8例，可3例。
结论：抗生素骨水泥联合外固定支架是治疗下肢开放性骨折骨缺损早期处理的有效方法。该方法操作简单、手术时间短、绝对优势控制感染、提供良好的植骨床，利用膜诱导技术植骨，获得良好的骨愈合。 |
| 【关键词】抗生素骨水泥 骨折，开放性 骨缺损 外固定器 |
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| Early application of the antibiotic-laden bone cement(ALBC)combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect |
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ABSTRACT
Objective: To discuss the curative effect of the early application of the antibiotic-laden bone cement(ALBC)combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect.
Methods: From December 2013 to January 2015,36 cases of lower limb open comminuted fractures complicated with bone defects were treated by the vancomycin ALBC combined with the external fixation support,including 26 males and 10 females with an average age of 38.0 years old ranging from 19 to 65 years old. The included cases were all open fractures of lower limbs complicated with bone defects with different degree of soft tissue injuries. Among them,25 cases were tibial fractures,11 cases were femoral fractures. The radiographs indicated a presence of bone defects,which ranged from 3.0 to 6.1 cm with an average of 4.0 cm. The Gustilo classification of open fractures:24 cases were type ⅢA,12 cases were typr ⅢB. The percentage of wound infection,bone grafting time,fracture healing time and postoperative joint function of lower limb were observed. The function of injured limbs was evaluated at 1 month after the clinical healing of fracture based on Paley evaluation criterion.
Results: All cases were followed up for 3 to 24 months with an average of(6.0±3.0)months. The wound surface was healed well,neither bone infections nor unhealed bone defects were presented. The reoperation of bone grafting was done at 6 weeks after the patients received an early treatment with ALBC,some of them were postponed to 8 weeks till the approximate healing of fractures,the treatment course lasted for 4 to 8 months with an average of(5.5±1.5)months. According to Paley and other grading evaluations of bone and function,there were 27 cases as excellent,5 cases as good,3 cases as ordinary.
Conclusion: The ALBC combined with external fixation support was an effective method for early treatment to treat the traumatic lower limb open fractures complicated with bone defects. This method was typified with the advantages such as easy operation,short operation time,overwhelming superiority in controlling infection and provision of good bone grafting bed,a good bone healing can be realized by the use of membrane induction technology for bone grafting. |
| KEY WORDS Antibiotic-laden bone cement(ALBC) Fractures,open Bone defect External fixators |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 肖坚,毛兆光,朱慧华,郭亮.抗生素骨水泥联合外固定支架在下肢开放性骨折骨缺损中的早期应用[J].中国骨伤,2017,30(3):270~273 |
| 英文格式: | XIAO Jian,MAO Zhao-guang,ZHU Hui-hua,GUO Liang.Early application of the antibiotic-laden bone cement(ALBC)combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(3):270~273 |
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