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。

Therapeutic effect of multiple techniques in treatment of refractory osteomyelitis

ObjectiveTo investigate the clinical efficacy of Ilizarov bone transplantation combined with antibiotic bone cement tablets and Masquelet technique in the treatment of chronic osteomyelitis of long bones. MethodsFrom June 2012 to October 2016, 20 patients with chronic osteomyelitis and infectious nonunion of femur and tibia were treated by combination of focal debridement, Ilizarov technique, antibiotic bone cement filling technique, membrane-induced osteogenesis technique and slow distal retraction technique in the Department of Traumatic Orthopaedics, General Hospital of Xinjiang Military Region. Inclusion criteria: chronic osteomyelitis complicated with nonunion or bone defect; poor routine treatment effect; no complication affecting treatment; complete case data. Exclusion criteria: the patients who do not meet the inclusion criteria of diseases, or with active tuberculosis, cancer and other diseases, poor compliance, can not adjust the external fixator according to doctor’s requirements.Whether the above patients need skin flap transfer operation, time of external fixator, time of full weight bearing and recurrence were recorded. ResultsAll the patients were followed up for(29.2±1.8)months. Good bone healing was achieved in all the patients.All the infected wounds healed at the first stage. The wounds were closed without skin flap transfer or skin grafting. Bone transplantation combined site healed well. The length of bone movement was (7.3±1.8)cm on average. There was no nerve injury in all the patients. Two patients had common peroneal nerve injuries before operation, and different degrees of nerve function recovery occurred during bone transfer after operation. ConclusionsIlizarov’s bone transplantation and bone lengthening technique can effectively treat bone defect or limb shortening after thorough debridement, it can also improve local blood supply, heal wound without skin flap coverage; antibiotic bone cement tablets not only act as space holder, but also membrane induction for osteogenesis. The combination of various methods can effectively improve the cure rate of refractory osteomyelitis, which is a safe and effective treatment method.