分期诱导膜与胫骨滑移植骨治疗感染性距骨缺损△

Staged induced membrane and tibial sliding bone graft for septic talar defect

摘要:

［目的］介绍分期诱导膜与胫骨滑移植骨治疗感染性距骨缺损的手术技术和初步临床效果。［方法］患者，男性，18 岁，因交通伤致距骨开放性粉碎性骨折，一期踝关节融合术后感染引起距骨骨髓炎，行距骨部分切除，经两阶段抗生素骨水泥诱导膜技术填充骨缺损，在控制感染后取出骨水泥行胫骨滑移和自体髂骨植骨融合。［结果］术后 3 个月开始部分负重行走。术后 4 个月，完全负重行走。VAS 评分由术前 6 分降低到术后 3 个月 3 分，术后 8 个月 1 分。AOFAS 术后 8 个月功能评分 71 分。 术后 8 个月影像检查显示骨性融合。［结论］诱导膜与胫骨滑移植骨治疗感染性距骨骨缺损是一种可行且安全有效的方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of staged induced membrane and tibial slid- ing bone grafting for septic talar defect. [Methods] A 18-year old male suffered from open comminuted fracture of talus by traffic accident. Talus osteomyelitis occurred after one-stage debridement and ankle fusion. After that, partial talar resection, debridement and antibiotic bone cement for induction membrane was conducted in other two stages. As the infection was controlled completely, the bone cement was taken out for tibial sliding bone grafting combined with an iliac bone autograft. [Results] The patient was followed up for 8 months, re- sumed partial weight-bearing walking at 3 months and full weight-bearing activity at 4 months after operation. The VAS score decreased from 6 points preoperatively to 3 points at 3 months and 1 point at 8 months postoperatively. The AOFAS score was of 71 at 8 months post- operatively, with bony fusion on radiographs. [Conclusion] The staged induced-membrane combined with tibial sliding bone graft is a safe and effective method for treating infectious talus defect.