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

Open bone grafting as the treatment for the infected fracture nonunion

Objective To introduce the technique of open bone grafting for the infected fracture nonunion, and to explore the key factors assuring the satisfactory result. Methods 126 cases of infected fracture-nonunions or bone defects were reviewied, which involved 98 males and 28 females with an average age of 35 years( range, 15-71 years). The data consisted of 96 cases of tibial fractures, 12 femoral fractures, 5 humeral fractures, 6 ulnar fractures and 2 radial fractures as well as 5 both ulnar and radial fractures. The range of segmental bone defect was 1.5-6.5 cm (average, 3.5 cm). The procedure included thorough debridement, resection of the devitalized soft tissue and bone until bleeding at the fracture ends. Fractures were stabilized with external fixator or plaster. In cases of stable fracture with mild osteoporosis and expected shorter affected period, unilateral frame was the choice; while in cases for unstable fracture with moderate osteoporosis as well as an expected longer affected period, a two-plane unilateral frame was necessary; and in the severe osteoporosis, not only the frame with multiple pin fixation, but the plaster were also applied, and in the fractures close to the joints, the "bridging fixator" and /or plaster was recommended. One-stage or staged bone grafting with autogenous cortico-cancellous bone chips(diameter < 5 mm) were performed. The wound was left open with dressing change after operation, and systemic sensitive antibiotics were given for an average of 11 days. Results The average follow-up duration was 2.4 years. 123 cases achieved bony union during the follow-up of 7 months averagely with a range of 3.5 to 11 months. There were also 3 cases with fracture nonunion, 4 with sinus formation and 2 infection recurrence. Conclusion Comparing with conventional method, this protocal is easy, practical, active and time-saving. Infection is not an absolutely contraindication for bone-grafting. Radical debridement, stable external fixation, bone grafting with a large amount of bone chips, opening the wound and careful dressing change are all the key procedures to guarantee the satisfactory outcome.