摘要
目的:探讨应用扩髓清创联合单边外固定架固定治疗长骨骨折髓内钉术后慢性感染的临床疗效。方法:回顾性分析2014年1月至2018年1月收治的22例下肢长管状骨骨折髓内钉固定治疗术后慢性感染的患者资料，男16例，女6例；年龄21~62岁，平均（38.4±9.3）岁；股骨12例，胫骨10例。其中15例初始损伤为闭合性骨折；7例为开放性骨折。根据Cierny-Mader骨感染分型，I型（髓内型）10例，Ⅰ型+Ⅲ型（局灶型）7例，Ⅰ型+Ⅱ型（弥漫型）5例。22例患者均取出髓内钉，进行扩髓和冲洗髓腔，彻底清除髓腔内外感染及坏死的组织。对于同时存在窦道和脓肿者，将感染的软组织一并彻底清除；对于合并局灶型感染者，将感染及坏死的骨质做局部切除，局部骨缺损感染控制后二期重建，骨缺损较大的，行截骨骨搬运治疗。所有患者术后静脉滴注敏感抗生素2周，后改成口服4周，共计6周。结果:22例患者随访16~36个月，平均（24.5±4.1）个月，20例患者无感染复发或遗留感染，其中1例患者出现皮肤软组织感染，给予换药后伤口愈合。1例患者骨质外露，部分皮肤缺损，给予局部皮瓣转移覆盖创面后好转。12例骨折感染病灶清除后合并有骨缺损者，其中10例患者在感染控制后行取骨植骨术重建骨缺损，2例患者行骨搬运治疗。所有患者均获得骨折愈合。结论:应用扩髓清创联合外固定架固定是治疗长骨骨折髓内钉术后慢性感染的有效方法。
Abstract
Objective:To investigate the clinical effect of reaming and debridement combined with unilateral external fixator in the treatment of chronic infection after intramedullary nailing of long bone fractures.Methods:The data of 22 patients with chronic infection after treatment with intramedullary nails for long bone fractures of the lower extremity who were treated from January 2014 to January 2018 were retrospectively analyzed. There were 16 males and 6 females; age ranged from 21 to 62 years, with an average of (38.4±9.3) years old; 12 cases of femoral infection and 10 cases of tibial infection. Fifteen of the initial injuries were closed fractures; seven were open fractures. According to the Cierny-Mader classification of bone infection, there were 10 cases of type I (intramedullary type), 7 cases of type Ⅰ+ type Ⅲ (focal type), and 5 cases of type Ⅰ+ type Ⅱ (diffuse type). The intramedullary nails were removed from all 22 patients, and the pulp was reamed, meanwhile the pulp cavity was flushed. The infected and necrotic tissue inside and outside the pulp cavity was completely removed. For those with sinus tract and abscess at the same time, the infected soft tissue should be completely removed together; for those with focal infection, the infected and necrotic bone should be partially excised, and the local bone defect should be rebuilt after the infection was controlled in two stages. Bone transfer treatment were conducted in large bone defect. All patients received intravenous infusion of sensitive antibiotics for 2 weeks, and then changed to oral administration for 4 weeks, for a total of 6 weeks.Results:Twenty-two patients were followed up for 16-36 months, with an average of (24.5±4.1) months. There was no recurrence of infection or residual infection in 20 patients. One patient had skin and soft tissue infection, and the wound healed after dressing change. One patient had bone exposure and partial skin defect, and the wound improved after local skin flap was transferred to cover the wound. 12 patients with bone defect after infection and debridement, 10 patients underwent bone grafting after infection control to reconstruct bone defect, and 2 patients underwent bone transfer. All patients achieved fracture union.Conclusion:Reaming and debridement combined with external fixation is an effective method for chronic infection after intramedullary nailing of long bone fractures.
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