膜诱导技术治疗Cierny-MaderⅣ型股骨慢性骨髓炎△

Membrane induction technique for Cierny-Mader type IV chronic osteomyelitis of the femur

摘要:

［目的］探讨膜诱导技术治疗 Cierny-Mader Ⅳ型股骨慢性骨髓炎的临床疗效。［方法］2016 年 1 月—2019 年 12 月， 对 42 例Ⅳ型股骨骨髓炎患者行两阶段手术，第一阶段彻底清创后采用膜诱导技术结合内固定治疗，第二阶段手术植骨并调整内固定，观察围手术期、随访及影像资料。［结果］一期手术后骨缺损长度 5~16 cm，平均（8.24±1.16）cm， 一期手术时伤口均闭合。两期手术间隔 6~16 周，平均（9.21±1.83）周，二期手术后伤口均闭合。平均随访时间（24.71±3.13）个月，随时间推移， 髋、膝伸屈活动度、Harris 和 HSS 评分均显著增加（P<0.05），Paley 骨缺损愈合评级显著改善（P<0.05）。末次随访时，所有患者均获得影像骨折缺损愈合，愈合时间为 6~16 个月。［结论］彻底清创后采用膜诱导技术结合内固定治疗 Cierny-Mader Ⅳ型股骨慢性骨髓炎能够有效控制感染，达至骨缺损愈合。

Abstract:

[Objective] To investigate the clinical efficacy of membrane induction technique in the treatment of Cierny-Mader type IV chronic osteomyelitis of the femur. [Methods] From January 2016 to December 2019, 42 patients with Cierny-Mader type IV osteomyelitis of the femur were treated with two stages of surgery. In the first stage a thorough debridement followed by antibiotic bone cement filling com- bined with internal fixation were conducted, while in the second stage bone grafting and internal fixation adjustment were performed second- ary to bone cement removal. The documents regarding to clinical setting and imaging were observed. [Results] The length of bone defect ranged from 5 to 16 cm with an average of (8.24±1.16) cm after the thorough debridement in the first stage with well wound closure. The inter- val between the two stages of surgery was 6~16 weeks, with an average of (9.21±1.83) weeks, and the incision healed well after the second stage of surgery. As time went during the follow-up time lasted for (24.71±3.13) months, the range of motions (ROMs) of both hip and knee, as well as Harris and HSS scores significantly increased (P<0.05) , and Paley grade for bone defect healing significantly improved (P<0.05) . At the latest follow- up, all patients achieved radiographic fracture healing with healing time ranging from 6 to 16 months. [Conclusion] This membrane induction technique combined with internal fixation is an effective treatment for Cierny-Mader type IV chronic osteomyelitis of the femur with a benefit of high-efficient control of infection to achieve bone healing.