Ⅰ期开放植骨治疗伴有感染性骨缺损的开放性骨折

目的探讨Ⅰ期开放植骨治疗伴有感染性骨缺损的开放性骨折的可行性,总结提高治疗成功率的因素。方法13例伴有感染性骨缺损的开放性骨折患者,均为男性;年龄17～51岁,平均年龄36岁。骨缺损1.5～4cm,平均2.5cm。采用患处换药、清创、外固定架固定骨折,清创后Ⅰ期行自体松质骨开放植骨,骨条直径〈5mm。术后严格无菌换药,静脉滴注敏感抗生素,术后平均用药21d。结果平均随访20个月。术后移植骨条表面覆盖肉芽组织时间平均8周,创面完全闭合时间平均13周。所有骨缺损处经植骨后均骨性愈合,平均骨愈合时间6个月,未发现感染复发者。结论Ⅰ期开放植骨术是治疗伴有感染性骨缺损的开放性骨折简单可行的方法。与传统方法相比缩短了疗程、简化了治疗方法。

Feasibility of one-stage open bone grafting in the treatment of infected bone defect in open fracture

Objective To investigate the feasibility of one-stage open bone grafting in the treatment of infected bone defect in open fracture.Methods The data of thirteen male patients（age range：17~51yr,average age：36yr）with infected bone defect caused by open fracture were retrospectively analyzed,which included 12 cases of tibial defect and 1 cases of femoral defect.The range of bone defect was 1.5 to 4 cm（average 2.5cm）.The treatment procedure included dressing change,debridement and external fixation.After the debridement,the one stage open bone grafting was performed with autogenous bone chips,which was less than 5 mm in diameter.The dressing was changed regularly after operation,and antibiotics were given for an average of 21 days.Results The average follow-up period was 20 months.The wound was covered with granulation tissue for average 8 weeks and was closed for average 13 weeks after operation.All the bone defects were unioned after bone grafting（average 6 months）and no infection case recurred.Conclusion The one-stage open bone grafting is optional therapy for infected bone defect in open fracture.