骨感染

20061294 载药自固化磷酸钙人工骨治疗慢性骨髓炎／陈红卫…∥中国骨与关节损伤杂志．-2005，20（10）．-673～675 自2002年1月起，对8例慢性骨髓炎患者，行彻底清创后，一期植入载药自固化磷酸钙人工骨（CPC）。结果：该组均获随访，随访时问为11-35个月，平均21．3个月，1例发生术后伤口表浅感染，随访期间均无骨髓炎复发，未见明显的全身反应，无再骨折，x线片显示，术后骨髓炎区被CPC充分填塞，随访时CPC部分降解成骨。结论：在病灶清除后，一期将载药自固化磷酸钙人工骨植入残留的感染性骨缺损是治疗慢性骨髓炎的较理想的方法。图2参10     

一期病灶清除载药磷酸钙人工骨充填治疗慢性骨髓炎

目的 探讨一期病灶清除载药磷酸钙人工骨(CPC)充填治疗慢性骨髓炎的临床疗效:方法 22例慢性骨髓炎患者行彻底清创后,一期植入载药CPC.结果 22例获随访(26.3±6.5)个月,患者术后均未出现过敏或毒性反应,无皮疹或高热;随访期间均无骨髓炎复发.未见明显的全身反应,无再骨折;X线片显示植入CPC与宿主骨接触紧密,界面处未见间隙存在,骨缺损处的解剖形状完全或大部分恢复,未见脱落现象,随访期内18例患者CPC部分降解成骨.结论 在病灶清除后,载药CPC一期充填残留的感染性骨缺损治疗慢性骨髓炎可有效控制感染.     

载药自固化磷酸钙人工骨治疗慢性骨髓炎

慢性骨髓炎临床处理颇为困难，传统方法采用分期手术，先控制感染，消灭创面，待骨髓炎静止后再修复骨缺损，故疗程长，费用高，随着观念的不断更新，摘除死骨并植骨在临床上被逐步采用。我们自2002年1月至2004年4月，对8例慢性骨髓炎患者行彻底清创后，一期植入载药自固化磷酸钙人工骨(CPC)，取得了满意的临床疗效，现报告如下。     

自固化磷酸钙人工骨修复骨缺损的临床应用

目的:探讨自固化磷酸钙人工骨(CPC)填充修复骨缺损的临床效果。方法:骨缺损94例,男59例,女35例;年龄11~72岁,平均39.4岁。骨缺损部位:胸腰椎38例,跟骨25例,胫骨15例,股骨7例,肱骨近端3例,桡骨远端5例,近节指骨1例。骨缺损原因:骨折塌陷复位后骨缺损63例,骨髓炎20例,骨囊肿6例,骨纤维异常增殖症4例,内生软骨瘤1例。骨缺损范围为1cm×1cm~4cm×20cm,用CPC填充修复,CPC充填量为3~42g,其中单纯CPC填充修复74例(胸腰椎骨折行椎体成形38例,骨折复位后空腔充填25例,良性骨肿瘤病灶刮除后充填11例),载药CPC填充修复骨髓炎20例。结果:所有患者均获随访,随访时间14~48个月,平均29.6个月。全部患者术后未见过敏或毒性反应,无皮疹或高热,血钙、磷、碱性磷酸酶均正常,切口无瘙痒感。随访时X线片显示,植入CPC与宿主骨接触紧密,界面处未见间隙存在,骨缺损处的解剖形状完全或大部分恢复,未见脱落现象,随访时部分患者CPC部分降解成骨。9例发生术后伤口渗出,为淡黄色清亮稀薄分泌物,细菌培养阴性,经换药后伤口愈合良好。结论:CPC填充修复骨缺损安全有效,并发症少,是理想的骨替代品,载药CPC是治疗骨髓炎的理想方法。     

Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎

目的探讨Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎的临床疗效。方法自2011年3月至2015年12月治疗本院的慢性管状骨骨髓炎患者12例,男7例,女5例,均Ⅰ期行病灶清除、载抗生素人工骨植入、Ilizarov环形外固定架固定、干骺端微创截骨、创面修复。术后1周左右开始骨搬移。结果 12例患者均获得6~24个月随访,平均17.5个月,均获得稳定骨愈合及良好的皮肤软组织愈合。骨外固定时间6~13个月,平均7.35个月。人工骨在影像学上的吸收时间1~3月,平均2.1月。结论 Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎具有良好疗效,值得临床推广。     

合并软组织缺损的复杂创伤性骨髓炎的一期治疗

目的 探讨组织瓣结合载抗生素人工骨植骨一期治疗合并软组织缺损的复杂创伤性骨髓炎的疗效.方法 施行组织瓣移植或转位修复软组织缺损,同时予载抗生素人工骨植骨,一期治疗骨髓炎以及软组织缺损共41例.2例骨髓炎术后复发,再次植入载抗生素人工骨后治愈,1例发生骨不连再次自体髂骨植骨后治愈.结果 随访4个月～2年,骨折愈合时间为3～9个月,平均5.3个月,创面平均愈合时间3.7周,软组织缺损均一期修复,骨髓炎最终均获治愈.结论 彻底清创,以组织瓣修复软组织缺损,同时植入载抗生素人工骨,一期治疗伴有软组织缺损的复杂性创伤性骨髓炎的方法是可行而且有效的.     

四肢开放性骨折伴骨缺损治疗方法的研究

目的 探讨一种简单、安全、有效的治疗开放性骨折伴骨缺损方法。方法 对98例开放性骨折伴骨缺损的病人在清创,适当固定后采用：①载药自固化磷酸钙人工骨植入;②抗生素伴自体骨植入;③早期关闭创口,后期取带血管蒂的骨块伴载药自固化磷酸钙人工骨植入。结果 对轻中度污染,骨缺损量较少的开放性骨折伴骨缺损者,采用载药自固化磷酸钙人工骨植入及抗生素伴自体骨植入治疗,二者无明显差异。对污染较重的开放性骨折伴骨缺损者,适用于载药自固化磷酸钙植入治疗。对污较重且伴有节段性缺损大于5cm的开放性骨折伴骨缺损者,适用于早期清创,后期取带血管蒂的骨块伴载药自固化磷酸钙人工骨植入治疗。结论 对开放性骨折伴骨缺损,应根据骨缺损量的多少及污染的程度选用合适的方法,以免多次手术。     

早期经皮椎体成形术治疗胸腰椎骨折

目的探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗胸腰椎压缩性骨折的临床疗效。方法自2004年9月对17例胸腰椎压缩性骨折患者,采用术中手法复位,经皮用髓核钳于伤椎内造穴,自固化磷酸钙人工骨充填。结果17例患者椎体高度恢复正常,无后凸畸形,均于术后1个月内下床活动;随访4~22个月无矫正度丢失,无双下肢神经症状。结论经皮椎体成形自固化磷酸钙人工骨充填治疗胸腰椎压缩性骨折是一种安全、简单、有效的治疗方法。     

胫腓骨中下段开放性骨折伴骨缺损58例治疗分析

目的探讨胫腓骨中下段开放性骨折伴骨缺损患者的治疗方法。方法2000年1月至2006年12月采用载药人工骨或者载药自体骨植入治疗胫腓骨中下段开放性骨折伴骨缺损66例,将骨折固定分为钢板、髓内针、外固定架固定,其中58例资料完整,男31例,女27例;年龄9～72岁,平均36.4岁。分别采用载药自固化磷酸钙人工骨植入（甲组）37例、自体骨伴抗生素植入（乙组）17例、带血管蒂肌皮瓣修复关闭伤口和载药自固化磷酸钙人工骨植入（丙组）4例,伤口闭合直接缝合、减张缝合加游离植皮、Ⅱ期缝合游离植皮、皮瓣转移、带血管髂骨瓣修。结果58例获得随访,随访1.2～6年,平均1.6年。甲组优23例,良11例,可2例,差1例,优良率为91%。乙组优10例,良5例,可2例,差0例,优良率为88%。丙组优0例,良1例,可1例,差2例,优良率为25%。结论采用载药自固化磷酸钙人工骨植入或自体骨伴抗生素植入治疗骨缺损均可取得较好的治疗效果,但是载药自固化磷酸钙无生物活性,骨质生长较自体骨植入慢,且价格较贵。自体骨植入多取自髂骨,骨折生长快、效果好,但同时增加新损伤和感染的可能,而且受到骨量的限制。     

载重组人BMP-2磷酸钙联合载抗生素磷酸钙人工骨治疗慢性骨髓炎伴骨缺损的临床研究

目的 通过与单纯载抗生素磷酸钙人工骨(calcium phosphate cement,CPC)比较,探讨载重组人BMP-2(recombinant human BMP-2,rhBMP-2)CPC联合载抗生素CPC一期治疗慢性骨髓炎伴骨缺损的疗效.方法 采用单盲、前瞻性临床随机对照试验,以2018年4月-2019年4月...     

多种技术联用治疗难治性骨髓炎的疗效分析

目的探讨应用Ilizarov骨搬移技术联合抗生素骨水泥片技术、Masquelet技术(膜诱导技术)等技术治疗长骨慢性骨髓炎的临床疗效。 方法回顾性分析2012年6月至2016年10月,新疆军区总医院创伤骨科联合应用病灶清除、Ilizarov技术、抗生素骨水泥片填充技术、膜诱导成骨技术、远端缓慢回缩技术等技术治疗的20例股骨、胫骨慢性骨髓炎和感染性骨不连患者。纳入标准：慢性骨髓炎合并骨不连或骨缺损的患者;经常规治疗效果差的患者;无影响治疗的合并症;病例资料完整的患者。排除标准：不符合疾病的纳入标准;存在活动性结核、肿瘤等疾病的患者;依从性差、不能按照医生要求调整外固定架的患者。记录上述患者是否需行皮瓣转移手术、带外固定架时间、全负重时间及是否出现复发情况。 结果所有患者均得到随访,随访时间平均(29.2±1.8)个月。均获得了良好的骨性愈合,所治疗患者感染均得到一期愈合,创面无需皮瓣转移或植皮均得到良好闭合,骨搬移结合处愈合良好。患者骨搬移长度平均(7.3±1.8)cm。所有患者未出现神经损伤,其中有两例患者术前存在腓总神经损伤,术后在骨搬移过程中出现不同程度的神经功能恢复。 结论应用Ilizarov的骨搬移和骨延长技术能有效治疗彻底清创后的骨缺损或肢体短缩问题,保证彻底清创、促进局部血运改善、不需要皮瓣覆盖也能愈合创面;抗生素骨水泥片起到占位器和膜诱导作用促进成骨;远端缓慢回缩有利于骨端愈合;多种方法联合应用,有效地提高了难治性骨髓炎的治愈率,是一种安全有效的治疗方法。     

负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎的临床研究

目的 :研究负压封闭引流联合负载万古霉素硫酸钙与自体骨在治疗慢性骨髓炎中的疗效。方法 :2013年6月至2016年12月治疗35例慢性骨髓炎患者,男23例,女12例;年龄11~65岁,平均34岁;病程8~46个月,平均26个月。所有患者为开放性创伤导致的慢性骨髓炎,病灶局部有反复红肿及脓液穿破皮肤病史。32例窦道分泌物细菌培养阳性,3例窦道分泌物细菌培养阴性。影像学检查显示病灶存在骨破坏、骨缺损,周围有骨质增生硬化。Ⅰ期行彻底清创,清除病灶坏死及炎性组织,负压封闭引流敷料完全覆盖创面,以促进创面的修复。Ⅱ期将负载万古霉素硫酸钙与自体髂骨松质骨混合为移植骨复合体,均匀填充病灶。观察患者伤口愈合情况,并对病灶进行X线检查,了解硫酸钙吸收及新骨生长情况。结果:26例行1次清创加负压封闭引流,6例行2次清创加负压封闭引流,3例行3次清创加负压封闭引流。32例伤口甲类愈合,2例乙类愈合的患者经抗感染、伤口换药等治疗后伤口完全愈合。1例丙类愈合的患者于术后4周时再行清创,伤口正常愈合。所有患者病灶处未再次出现皮肤红肿及破溃,X线片显示植入的硫酸钙4周左右开始逐步吸收,8周左右有新骨生成,6~24个月病灶区骨缺损完全愈合。结论:负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎,临床疗效良好、可靠,值得临床推广。     

腓肠神经营养血管远端蒂皮瓣结合抗生素硫酸钙治疗跟骨慢性骨髓炎

背景:跟骨慢性骨髓炎是跟骨骨折术后发生的较为严重的并发症之一,其发生率日益增加,且处理较为棘手.目的:探讨应用腓肠神经营养血管远端蒂皮瓣及抗生素硫酸钙治疗跟骨慢性骨髓炎的方法和疗效.方法:回顾性研究2016年1月至2019年10月治疗的19例跟骨骨折所致跟骨慢性骨髓炎患者,男11例,女8例;年龄35～65岁,平均(45...     

Oral ciprofloxacin compared with standard parenteral antibiotic therapy for chronic osteomyelitis in adults

A group of fourteen patients who had chronic osteomyelitis and were treated with oral ciprofloxacin was compared with a group of twelve patients of similar age who had chronic osteomyelitis and received standard parenteral antibiotic therapy consisting of nafcillin, clindamycin, and gentamicin, singly or in combination. The osteomyelitis was arrested at the end of therapy and on follow-up examination of eleven patients in the first group and ten in the second group. The average duration of antibiotic therapy (thirty-eight days) and follow-up (approximately thirty months) were about the same for both groups. Oral administration of ciprofloxacin was as effective and safe as parenteral therapy for the treatment of osteomyelitis in these adults.     

Expérience clinique des linguettes de plâtre chargées d'antibiotique dans le traitement des ostéites chroniques

This paper reports a series of 68 patients with chronic osteomyelitis treated by debridement and filling the cavities with Paris plaster pellets loaded with antibiotics (cefazolin or amoxicillin). The evolution of more than the half of the cases was over 5 years. The results were satisfactory in 64.7 % of the cases with a 2.5 years mean follow up (3 months to 7 years). The causes of the failures were the lack of complete debridement, of efficient antibiotherapy or too short duration of the antibiotic treatment. This technic is finally compared with the other methods usually applied in the treatment of osteomyelitis. Indications are defined and some modifications of this technic are suggested.     

Chronic progressive osteoblastic osteomyelitis: a new approach to treatment

The clinical, histologic and radiographic picture in 16 cases in 15 patients with nonfistulating chronic progressive osteoblastic osteomyelitis of a long tubular bone which started in childhood is presented. All patients had severe pain at rest or weightbearing. Histology showed an increase of active osteoblasts. Low virulent bacteria were found in one-fourth of the patients. To reduce the osteoblastic activity, nonsteroidal antiinflammatory treatment was combined with surgical and antibiotic treatment. Eleven patients were pain-free at follow-up (average 47 months), 3 had reduced pain, and 1 patient did not respond to treatment.     

Chronic osteomyelitis of the pelvis in children and adolescents

Osteomyelitis of the pelvis is rare in children as well as in adults. This explains why the diagnosis is often missed, so that the infection becomes chronic. The authors report five chronic paediatric cases, seen between 1993 and 2003. The diagnosis was initially missed in two patients. In two others, the osteomyelitis was recognised but insufficiently treated, so that it also became chronic. The fifth patient developed exogenous osteomyelitis 6 months after an open pelvic fracture. The bone scan was useful for the differential diagnosis, but laboratory and radiographic findings were not. Treatment was the same for all patients, including wide surgical debridement, antibiotic therapy and prolonged immobilisation. Four patients were free of symptoms at the last clinical evaluation, after an average follow-up period of 7 years. Only one patient had a recurrence 3 months postoperatively and was re-operated. This study demonstrates that surgical treatment of chronic pelvic osteomyelitis in children and adolescents yields encouraging results.     

A Case of Brodie's Abscess in Distal Radius of Pediatric following Percutaneous Fixation

Distal radius fractures are among the most common pediatric fractures. In unstable fractures, treatment methods include closed or open reduction and percutaneous pinning with Kirschner wire (K-wire). This report presents a 13-year-old boy with an unstable distal radius and ulnar fractures, following an accident, who was treated with open reduction and K-wire fixation. He had pain and limited wrist range of motion for 6 months. Conventional radiography revealed a lytic lesion with evident sclerotic margin. Chronic osteomyelitis and Brodie''s abscess were also indicated. A complete curettage and antibiotic therapy for 3 months was successful. Culturing results showed that Staphylococcus aureus and pathologic findings were in favor of chronic osteomyelitis. Subacute osteomyelitis and Brodie''s abscess are rare retarded complications in percutaneous pinning of distal radius pediatric fractures. The curettage of the lesion and antibiotic therapy for at least 3 months would be successful and could result in good prognosis among children.     

Acute compartment syndrome following intramedullary pulse lavage and débridement for osteomyelitis of the tibia

The implantation of gentamicin loaded polymethylmethacrylate (PMMA) beats and other local antibiotic carriers is a common practice in the treatment of chronic osteomyelitis as is the use of local jet lavage débridement. This article presents the case of a patient with chronic osteomyelitis of the tibia, who had no complication after débridement, intramedullary reaming and pulse lavage without tourniquet but sustained a compartment syndrome 2 weeks later during a second procedure in which an intraoperative tourniquet and pulse lavage were combined.     

Coverage of the infected wound.

Fifty-four consecutive patients with chronic wounds were identified by the following criteria: (1) established infection for 6 months, (2) exposure of bone, mediastinum, or other vital structure, (3) mechanical and/or vascular limitations to delayed closure techniques, (4) no response to wound debridement in prolonged antibiotic therapy. These wounds were divided into four groups: osteomyelitis (21), pressure sore (17), soft tissue wound (10), and osteoradionecrosis (6). Wound treatment in all patients included debridement, muscle flap closure, and culture specific antibiotic therapy. These consecutively treated patients over a 4-year period presented with an average duration of chronic infection of 2.9 years. Ninety-three per cent of these patients after treatment have demonstrated stable coverage without recurrent infection with a minimum of 1 year and a maximum of 4.6 years follow-up. The results demonstrate safe, effective coverage (93% of patients) of chronic infected wounds associated with long bone and pelvic osteomyelitis as well as chronic perineal sinuses following proctocolectomy and osteoradionecrosis. Debridement with short-term (average 12 days) antibiotic therapy has been effective when muscle flap coverage is provided.