感染性骨不连伴大段骨缺损的治疗

目的 探讨颗粒状松质骨移植治疗感染性骨不连伴大段骨缺损的效果.方法 对19例(20个部位)感染性骨不连伴大段骨缺损患者进行清创、外固定、颗粒状松质骨移植方法 治疗,其中自体骨移植14例(15个部位),异体骨移植5例.结果 平均随访32.7个月(20～56个月).5例异体骨移植患者均无感染复发,其中3例获得骨愈合,外固定指数是(2.22±0.84)个月/cm;2例发生骨不连,再次手术取自体松质骨植骨获得骨愈合.14例(15个部位)自体骨移植患者,2例(2个部位,13.3%)感染复发导致植入骨吸收骨不连,接受再次清创自体骨移植获得骨连接、感染消灭;12例(13个部位,86.7%)骨愈合患者,外固定指数是(1.96±0.74)个月/cm.共3例(4个部位)发生再骨折,分别接受石膏固定、外固定支架及内固定获得骨愈合.结论感染性骨不连伴大段骨缺损采用自体颗粒状松质骨移植是合适的;异体骨移植骨不连发生率高、外固定时间长,应慎用.

Treatment of infected nonunion with large skeletal defects

Objective To investigate the curative effect of managing infected nonunion with large skeletal defects utilizing debridement and granulated cancellous bone grafting. Methods Nineteen patients (20 sites)of infected nonunion with large skeletal defects in tibiae (n = 18) or ulna/radii (n =2) , 18 males and 1 female aged 31.3 (8-51), were treated with debridement,external fixation, and granulated cancellous bone grafting,14 patients (15 sites) by cancellous bone autografting and 5 patients (5 sites) by cancellous bone allografting. Follow-up was conducted for 32. 7 (20 - 56) months. Results Out of the 5 patients receiving allogra-fting, 3 gained bone union with an external fixator index of ( 2. 22 ± 0. 84 ) months/cm, 2 developed nonunion and subsequently gained union after receiving cancellous bone autografting, and no infection recurrence all of the 5 patients were found. Out of the 14 patients (15 sites) undergoing autografting, 2 patients (2 sites, 13. 3% )developed nonunion due to recurrent infection resulting in absorption of autograft, subsequently received debridement and autograftiug once again, and gained bone union and infection eradication; 12 patients ( 13 sites, 86.7% ) gained bone union with an external fixator index: of (1.96 ± 0. 74) months/cm. Re-fracture occurred in 3 patients (4 sites) and was cured by using cast immobilization (1 case), external fixator (1 case), or internal fixation (1 case). Conclusion Granulated cancellous bone autografting is a suitable method for managing infected nonunion with large skeletal defects. And cancellous bone allografting has a higher incidence of re-nonunion and longer time for using external fixator.