环形外固定和膜诱导治疗胫骨近端感染性骨缺损

Circular external fixator combined with membrane induction for postoperative infectious bone defect secondary to internal fixation of proximal tibia fractures

摘要:

［目的］ 探讨环形外固定架联合膜诱导治疗胫骨近端骨折术后感染骨缺损的临床疗效。［方法］ 回顾性分析 2013— 2020 年，采用上述技术治疗胫骨近端骨折术后感染骨缺损 47 例患者的临床资料。Ⅰ期感染创面清创、环架固定，Ⅱ期进行植骨或骨搬移。记录患者临床及实验室检查结果。［结果］所有患者均顺利完成手术，无严重并发症。所有患者均获随访 6~62 个月，平均（23.62±4.54）个月，所有病灶愈合，无感染复发。随时间推移，患者的膝 ROM 和 HSS 评分显著增加（P<0.05）。实验室检测方面，术后深部创面培养出金黄色葡萄球菌共 23 例，里昂葡萄球菌 8 例，大肠埃希菌 12 例，鲍曼不动杆菌 4 例。术后 6 个月 WBC、CRP 和 ESR 均较术前显著降低（P<0.05）。［结论］通过环形外固定架联合膜诱导技术治疗胫骨近端术后感染骨缺损临床效果满意。

Abstract:

[Objective] To investigate the clinical outcomes of circular external fixator combined with membrane induction for postoper- ative infectious bone defect secondary to internal fixation of proximal tibia fractures. [Methods] A retrospective study was conducted on 47 patients who received abovementioned surgical treatment for postoperative infectious bone defect secondary to internal fixation of proximal tibia fractures from 2013 to 2020. A thorough debridement, antibiotic cement space implantation and fixation by a circular external fixator were conducted in the stage I, followed by removal of the cement, bone autografting or bone transportation by the frame in the stage II. The clinical and laboratory results were summarized. [Results] All the patients were successfully operated on without serious complications. All of them were followed up for 6~62 months with an average of (23.62±4.54) months, and got the lesions subsided without infection recur- rence. The knee range of motion (ROM) and HSS scores increased significantly over time (P＜0.05) . In terms of laboratory tests, pathogenic bacteria were identified from the deep wound, including Staphylococcus aureus in 23 cases, Staphylococcus Lyons in 8 cases, Escherichia coli in 12 cases and Acinetobacter baumannii in 4 cases. The WBC, CRP and ESR significantly decreased 6 months postoperatively com- pared with those before operation (P＜0.05) . [Conclusion] The circular external fixator combined with membrane induction in two stages does achieve satisfactory clinical outcomes for treatment of postoperative infected bone defect secondary to internal fixation of proximal tib- ia fractures.