一期植骨闭合创面治疗感染性胫骨骨缺损

目的探讨一期清创、植骨、皮瓣、肌皮瓣转移或移植治疗感染性胫骨骨缺损的可行性。方法自2000年12月至2005年1月，对8例感染性胫骨骨缺损骨折患者彻底清创，应用皮瓣、肌皮瓣转移或移植覆盖创面，对胫骨骨缺损同时行松质骨植骨及灌注冲洗。结果8例患者转移或移植的皮瓣、肌皮瓣均成活，伤口均一期愈合，植骨在术后7～9个月获得骨性愈合，经术后7个月至4年9个月随访，感染无复发，肢体行走功能及外观满意。结论对感染性胫骨骨缺损行彻底清创、松质骨植骨、皮瓣、肌皮瓣转移或移植、灌注冲洗是一种实用、有效的方法。     

开放植骨治疗严重胫骨感染性骨缺损

目的 介绍开放植骨治疗严重胫骨感染性骨缺损的方法 ,探讨与提高治愈率有关的因素.方法 26例感染性骨折不愈合或骨缺损患者,患处彻底清创,切除失活组织至骨折端点状出血,外固定架固定,一期或择期植入自体腓骨棒和(或)髂骨条,无张力缝合切口,油纱布覆盖.结果 4例于术后4～8周行游离植皮闭合创面,其余22例于术后7～22周瘢痕自行愈合,24例骨折于术后平均8个月愈合,10个月去除外固定物.结论 开放植骨术是治疗感染性骨折不愈合和骨缺损的简单、积极而有效的方法 ,感染并非植骨的绝对禁忌证.     

筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损

目的探讨筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损的效果。方法回顾分析2011年6月–2016年12月,采用筛网状筋膜包裹松质骨植骨治疗的21例外伤性四肢骨折后骨缺损患者临床资料。男13例,女8例;年龄14～64岁,平均40.1岁。骨缺损部位:肱骨3例,桡骨5例,尺骨4例,股骨2例,胫骨7例。原发骨折AO分型:A型2例,B型7例,C型12例。开放性骨折14例,闭合性骨折骨不连伴骨缺损7例。受伤至骨缺损修复时间为5～165 d,平均21.3 d。扩创后骨缺损长度2.5～6.5 cm,平均4.5 cm。结果手术时间86～130 min,平均101 min;术中出血量185～647 mL,平均316 mL。术后发生切口浅表感染1例,延期愈合2例;无神经血管损伤发生。21例均获随访,随访时间12～36个月,平均19个月。骨折临床愈合时间为2.5～7.0个月,平均5.4个月,无延迟愈合和骨不连发生,愈合率为100%。无深部感染或感染复发,无内固定物断裂和再骨折发生。末次随访时,骨缺损愈合分级均为优;患肢功能恢复分级为优12例、良7例、可2例,优良率90.5%。结论筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损具有筋膜取材及手术操作简便、无不良反应、费用低、效果满意等优点。     

筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损北大核心CSCD

目的探讨筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损的效果。方法回顾分析2011年6月–2016年12月,采用筛网状筋膜包裹松质骨植骨治疗的21例外伤性四肢骨折后骨缺损患者临床资料。男13例,女8例;年龄14～64岁,平均40.1岁。骨缺损部位:肱骨3例,桡骨5例,尺骨4例,股骨2例,胫骨7例。原发骨折AO分型:A型2例,B型7例,C型12例。开放性骨折14例,闭合性骨折骨不连伴骨缺损7例。受伤至骨缺损修复时间为5～165 d,平均21.3 d。扩创后骨缺损长度2.5～6.5 cm,平均4.5 cm。结果手术时间86～130 min,平均101 min;术中出血量185～647 mL,平均316 mL。术后发生切口浅表感染1例,延期愈合2例;无神经血管损伤发生。21例均获随访,随访时间12～36个月,平均19个月。骨折临床愈合时间为2.5～7.0个月,平均5.4个月,无延迟愈合和骨不连发生,愈合率为100%。无深部感染或感染复发,无内固定物断裂和再骨折发生。末次随访时,骨缺损愈合分级均为优;患肢功能恢复分级为优12例、良7例、可2例,优良率90.5%。结论筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损具有筋膜取材及手术操作简便、无不良反应、费用低、效果满意等优点。     

钛网包裹自体松质骨打压植骨修复桡骨节段缺损一例

目的介绍一种新的利用钛网包裹自体松质骨打压植骨修复桡骨节段缺损方法。方法 2011年10月,收治1例53岁机器击伤致左桡骨中下段开放粉碎性骨折合并5.4 cm桡骨缺损患者,待伤口愈合和局部皮肤条件改善后,二期采用切开复位钢板内固定和钛网包裹自体髂骨松质骨打压植骨修复桡骨节段骨缺损。结果术后4个月见断端连续性骨痂连接、初步植骨融合表现,局部无压、叩痛,腕关节功能轻度受限,达临床愈合标准;术后6个月断端植骨融合更清晰,腕关节活动度接近正常,Green-O’Brien腕关节功能临床评分90分,为良;术后12个月末次随访,骨折愈合及腕关节功能临床评分无变化。结论采用钛网包裹自体松质骨打压植骨修复桡骨节段缺损,不仅成骨快、愈合良好,且简便、安全。     

自体骨联合异体骨开放植骨治疗胫骨远端感染性骨缺损的疗效观察

目的评价采用自体松质骨联合同种异体骨开放植骨治疗胫骨远端大段感染性骨缺损的可行性及临床效果。方法自2010-01—2013-01,采用自体骨联合异体骨（2∶1）开放植骨治疗10例胫骨远端感染性骨缺损,骨缺损长度平均5.6（3-8）cm。先用外固定架固定骨折,调整恢复肢体长度及力线,彻底清创,取自体髂骨松质骨剪成直径约5 mm的微粒与同种异体骨2：1混合植入骨缺损处,使骨质稍高于皮肤并超过骨折远近端各1cm。结果 10例获得平均12（9-18）个月随访。术后平均7（5-9）周移植骨质表面被肉芽组织覆盖,7例（1例双侧）创面于术后8-11周自行瘢痕愈合,3例于术后9周行植皮术闭合创面。9例（1例双侧）骨折完全愈合,骨折愈合时间平均8（6-12）个月;1例因胫骨交锁髓内钉取出术后3个月再次骨折伴骨缺损（约8cm）,且术后骨折端不稳、骨缺损较大导致假关节形成,骨折不愈合。结论自体松质骨联合同种异体骨开放植骨是治疗胫骨远端大段感染性骨缺损的一种简单、有效方法。     

云南白药促进骨缺损修复及引导性骨再生的实验研究

目的：阐明云南白药促进骨缺损修复及引导性骨再生的愈合机制，为临床上治疗骨折提供理论依据。方法：36只新西兰兔制作桡骨缺损不愈合模型和引导性骨再生模型，随机均分用药组及对照组，手术后3d、1、3、5、10、12周取材，观察骨痂愈合程度的差异及骨痂组织学变化，结果：实验组有明显的促进骨缺损修复作用，并在引导性骨再生中的膜内成骨作用强于对照组，结论：云南白药对骨缺损修复及引导性骨再生有明显的促进作用。     

开放植骨治疗感染性骨折不愈合

目的介绍开放植骨治疗感染性骨折不愈合的手术方法,总结疗效,探讨提高治疗成功率的因素。方法126例感染性骨折不愈合或骨缺损患者,男98例,女28例;年龄15～71岁,平均35岁。胫骨骨折96例,股骨骨折12例,肱骨骨折5例,尺骨骨折6例,桡骨骨折2例,尺桡骨双骨折5例。骨缺损1.5～6.5cm,平均3.5cm。患处彻底清创,切除失活的软组织和骨组织,直至骨折端点状出血。对于轻度骨质疏松、稳定性骨折且预期病程短者可使用双臂单边单平面外固定架;对于明显骨质疏松、不稳定性骨折和(或)预期病程长者使用单臂双平面外固定架;对于严重骨质疏松者,使用单臂双平面外固定架固定并辅以石膏托外固定;邻近关节骨折,可考虑跨关节外固定架和(或)石膏固定。一期或择期植入带皮质的自体松质骨骨条,直径<5mm,开放伤口。术后严格无菌换药。静脉滴注敏感抗生素,平均用药11d。结果平均随访2.4年(8个月～4.5年)。术后平均8周移植骨质表面覆盖肉芽组织,14例于术后5周行游离植皮闭合创面,112例于术后平均10周瘢痕自行愈合。123例骨折于术后平均7个月愈合,9个月去除外固定;3例骨折未愈合。4例出现窦道,2例感染复发。结论开放植骨术是治疗感染性骨折不愈合和骨缺损的简单、积极而有效的方法。与传统方法相比,疗程缩短,手术次数减少。感染并非植骨     

植骨内固定术治疗股骨颈骨折

目的 探讨植骨内固定术治疗移位型和陈旧性股骨颈骨折的疗效。方法 本文回顾分析34例股骨颈骨折，采用植骨和内固定术治疗，所有病例新鲜骨折平均随访4．5年，陈旧性为4．9年，其中新鲜骨折Garden IV型11例，陈旧性23例。早期采用三刃钉固定15例和钉板固定1例，空心松质骨螺钉固定15例，DHS内固定2例，1例单纯行植骨术。植骨方式采用髂骨松质骨植骨23例，带肌蒂植骨11例。结果 骨折愈合率：新鲜骨折为100％，陈旧性骨折为82．6％；缺血坏死12例。比较单纯松质骨植骨和带肌蒂骨植骨治疗结果，骨愈合率分别为91．3％和90．9％，坏死率分为26．1％和54．5％。结论 正确认识股骨颈骨折的创伤病理特点，稳定的内固定和植骨术可提高骨折愈合率，单纯松质骨植骨发生股骨头坏死明显低于带肌蒂植骨。     

Ⅰ期开放松质骨植骨治疗感染性骨缺损

目的：探讨Ⅰ期开放松质骨植骨治疗感染性骨缺损的可行性,总结提高治疗成功率的因素。方法：12例感染性骨缺损患者,男8例,女4例;年龄22～68岁,平均42岁。其中跟骨骨缺损7例,胫骨4例,股骨1例。采用患处换药,刮除失活的软组织及骨组织,清创后Ⅰ期行自体松质骨植骨,伤口开放,术后创面爬满肉芽后行游离植皮治疗。结果：术后移植骨质表面覆盖肉芽组织时间平均24.1d,创面完全闭合时间平均30.3d,所有患者经过8～30个月（平均18个月）随访,所有骨缺损处经植骨后均骨性愈合,未发现感染复发者。结论：Ⅰ期开放植骨术是治疗感染性骨缺损简单可行的方法,术前刮除失活组织,术中彻底清除肉芽组织、充分植入松质骨及术后严格无菌换药是手术成功的关键。     

抗生素骨水泥珠链结合外固定架治疗感染性骨折不愈合

目的：探讨抗生素骨水泥珠链植入结合外固定架固定治疗感染性骨折不愈合的疗效。,方法：回顾分析22例感染性骨折不愈合患者,男20例,女2例;年龄21±74岁,平均（34．7±11．6）岁。骨折部位：股骨粗隆间3例、股骨干6例、股骨髁上2例、胫骨干9例、肱骨干2例。治疗过程分为3个步骤：先取出内固定物,清创后植入抗生素骨水泥珠链,Ⅰ期闭合伤口;1周后再次清创,更换抗生素骨水泥珠链,行外固定架固定;3个月后取出抗生素骨水泥珠链,取髂骨植骨。结果：随访15～28个月,平均（19．98±4．16）个月。1例胫骨干骨折和1例股骨粗隆问骨折患者分别于植骨术后2、3个月感染复发,其余20例患者感染控制良好。22例患者骨折全部愈合,愈合时间为植骨术后8-24周,平均（15．09±4．13）周。结论：彻底清创、抗生素骨水泥珠链植入结合外固定架固定及Ⅱ期植骨是治疗感染性骨折不愈合简单而有效的方法、     

Role of locking plates in treatment of difficult ununited fractures: a clinical study

Objective:To present our experience in treatment of difficult ununited long bone fractures with locking plate.Methods:Retrospective evaluation of locking plate fixation in 10 difficult nonunions of lon...     

Percutaneous autologus bone marrow injection in the treatment of delayed or nonunion

Background:

Bone marrow is a source of osteoprogenitor cells that are key elements in the process of bone formation and fracture healing. The purpose of the study was to ascertain the osteogenic potential of autologous bone marrow grafting and its effectiveness in the management of delayed union and nonunion.

Materials and Methods:

Twenty-eight patients with delayed union and three with nonunion of fracture of the long bones were treated with this procedure. Of these 28 cases, two patients had fracture shaft femur, one had fracture shaft ulna and 25 patients had tibial shaft fractures. The average time duration between procedure and injury was 25 weeks (range 14-53 weeks). The bone marrow was aspirated from the anterior iliac crest and injected percutaneously at the fracture site. The procedure was carried out as an outpatient procedure. All but five cases required one injection of bone marrow.

Results:

Union was observed in 23 cases. The average time of healing after the procedure was 12 weeks (range 7-18 weeks).

Conclusion:

The technique of percutaneous autologous bone marrow injection provides a very safe, easy and reliable alternative to open bone grafting, especially for early intervention in fracture healing process.     

Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion

Introduction Bone grafting plays a critical role in promoting bone healing in infected nonunion, although recurrent infection is of concern. Cancellous bone grafting as an antibiotic delivery system has been reported as an effective method to combat infections. In this study, we report the clinical results of vancomycin-impregnated cancellous bone grafting for the treatment of infected tibial nonunion.Materials and methods Between January 1996 and March 2001, 18 patients with infected tibial nonunion treated with vancomycin-impregnated cancellous bone grafting were available for follow-up. According to the Cierny-Mader classification, all patients belonged to type IVA and IVB osteomyelitis. Adequate debridement, stabilization with external fixation, and staged vancomycin-impregnated cancellous bone grafting were used in all patients. Regular clinical and radiographic follow-ups were conducted.Results Infection control was obtained in all 18 patients with a 100% infection arrest rate. Bone union was achieved in 13 of 18 patients at an average of 5.8 months. Bone union was obtained subsequently in the remaining five patients after closed nailing in four, and plating and bone grafting in one patient. Radiographs showed good consolidation and hypertrophy of grafted bone at an average follow-up of 48 months.Conclusion We conclude that vancomycin-impregnated cancellous bone grafting is a safe method for the treatment of infected tibial nonunion.     

自体骨复合抗生素一期植骨治疗感染性骨折不愈合

目的观察自体骨复合抗生素一期植骨治疗感染性骨折不愈合的临床效果。方法对15例感染性骨折不愈合患者采用自体骨复合抗生素一期植骨治疗。结果 15例获随访,时间8~16个月。骨折均获骨性愈合,时间5~14个月。感染均未复发。14例伤口一期愈合,1例伤口不愈合,行皮瓣转移后伤口愈合。术后6周14例血沉和C-反应蛋白均降至正常水平。术后12周,所有患者血沉和C-反应蛋白均基本正常。结论采用自体骨复合抗生素一期植骨治疗感染性骨折不愈合能有效控制感染,获得良好的骨折愈合。     

Management of infected femoral nonunions with a single-staged protocol utilizing internal fixation

Purpose

There are no reported series that specifically deal with repair of infected nonunions of the femur with revision internal fixation. We sought to determine whether a standardised treatment protocol we have used for 13 patients since 1992 results in a high union rate, resolution of infection, and a good functional outcome.

Methods

The study cohort included seven male and six female patients who presented to the senior author with an infected nonunion of the shaft of the femur. Eleven patients with a minimum of 2-year follow-up and between the ages of 19 and 75 years (mean 53.2 years) were included and evaluated. All patients underwent a single-staged protocol that includes an antibiotic “holiday”, then treating the infected nonunion with surgical debridement and hardware removal, local and systemic antibiotics, revision open reduction and internal fixation, and use of supplemental bone grafting. Great emphasis at the time of surgery is placed upon aggressive debridement, correction of any deformity, and obtaining stable internal fixation. We sought to report our success rate of nonunion repair, number of re-interventions, complication rate, final knee range of motion, and the ability to eradicate the infection using this treatment regimen.

Results

At most recent follow-up (mean 5.6, range 2-12 years), all patients had united and resolved their infections. Ten of the patients healed their nonunions with the fixation placed at the time of initial revision by us. Five patients required re-interventions to ultimately attain fracture union. Four patients had additional bone grafting procedures at the time of antibiotic bead removal. One of these four patients, who was later diagnosed with a nickel allergy, required three subsequent revision open reduction and internal fixations with bone grafting for hardware failure and persistent nonunion. A final patient underwent nail dynamisation with achievement of osseous union. Only one patient had less than 90° of knee flexion, although he previously had an extensor mechanism disruption and had only 15° of flexion noted at the time of initial surgery performed by us.

Conclusion

The results of this study indicate that our standard protocol for treatment of infected nonunion of the shaft of the femur is reliable at obtaining fracture union with a good functional result, while resolving infection despite the reliance upon internal fixation.     

骨痂植骨带锁髓内钉固定治疗增生型骨不连

目的分析骨不连的原因,探讨骨痂作植骨材料的可行性和优点及带锁髓内钉固定的优势.方法对48例增生型骨不连先顺行扩髓带锁髓内钉固定,骨折端钻孔并植入骨痂.结果所有病例均4～7个月内达骨性愈合.结论骨痂具有取材方便且与自体松质骨相同的促愈合生物学活性,带锁髓内钉具有固定牢固且对骨折端有一定加压作用,是增生型骨不连治疗的理想植骨材料和固定方法.     

Arthroscopically assisted percutaneous fixation and bone grafting of a glenoid fossa fracture nonunion

Arthroscopy is commonly used for evaluating intra-articular fracture patterns and assessing postfixation reduction; however, the use of arthroscopy for the definitive treatment of articular fracture nonunion has not been reported. This article describes a case of symptomatic glenoid fossa fracture nonunion that was successfully treated with arthroscopically assisted percutaneous screw fixation and bone grafting.A 48-year-old laborer sustained a glenoid fossa fracture following a fall from a height. An initial period of nonoperative management was attempted; however, the patient reported continued shoulder pain during his rehabilitation course. Imaging 5 months after injury showed no osseous union at the fracture. Using an arthroscopically assisted technique, percutaneous fixation and bone grafting of the nonunion with cancellous allograft was performed. Postoperatively, the patient progressed through a structured therapy program, and his pain improved. A computed tomography scan 4 months postoperatively showed osseous union at the fracture site.To the authors' knowledge, this is the first report in the literature of definitive arthroscopically assisted bone grafting and percutaneous fixation of a diarthrodial joint nonunion. Advantages of arthroscopic fixation of glenoid fossa fracture nonunion include avoiding potential axillary nerve injury and preserving the native subscapularis insertion, which may be important if subsequent procedures require access to the anterior access to the joint.     

带锁髓内钉内固定加经皮注射红骨髓治疗肱骨骨不连

目的 探讨采用Ｒｕｓｓｅｌｌ－Ｔａｙｌｏｒ扩髓型带锁髓内钉顺得内固定与植骨、术后注射红骨髓治疗肱骨骨不连。方法 肱骨骨不连患者２５例,以往平均手术次数２次,骨折后时间１０个月～４年,平均１年１０个月。用带锁髓内钉顺行静力型固定骨折端,取自体髂骨植骨缺损。术后１０ｄ于骨折区注射自体红骨髓。术后早期功能锻炼。平均随访时间１６个月。结果 所有病例均达到骨性愈合,平均愈合时间４．５个月,关节功能恢复很好。