自体微小颗粒骨植骨混合万古霉素开放性植骨修复感染性胫骨缺损

研究发现直径300—500μm微米结构的微小颗粒骨比直径4．0-5．0mm的经典颗粒骨更容易在非感染骨缺损中成活。目的：评价采用自体微小颗粒骨植骨混合万古霉素开放性植骨修复感染性胫骨骨缺损的可行性及临床效果。方法：选择28例胫骨感染性骨缺损或骨不连患者，其中男23例，女5例，平均年龄35．2岁；胫骨上段19例，胫骨中段2例，胫骨下段7例；开放性骨折术后感染病例17例，骨折术后感染合并骨不连11例。随访6—30个月观察创面及骨折愈合情况。结果与结论：术后平均6周移植微小颗粒骨表面被肉芽组织覆盖，平均8周创面完全闭合，经植骨后骨缺损处均骨性愈合，2例骨折愈合差，经二次植骨后达到骨性愈合，平均愈合时间5个月。未发生神经血管损伤及药敏反应。表明白体微小颗粒骨植骨混合万古霉素开放性植骨修复治疗感染性胫骨缺损是可行的。

Open autologous minimal morselized bone grafting with vancomycin repairs infected tibial defects

BACKGROUND： Studies have shown that 300-500 μm minimal morselized bone is easier than 4.0-5.0 mm morselized bone to survive in non-infected bone defects. OBJECTIVE： To investigate and evaluate the feasibility and clinical effect of open autologous minimal morselized bone grafting with vancomycin to treat infected tibial defects. METHODS： Twenty-eight patients with infected tibial defects or nonunion were treated with open autologous minimal morselized bone grafting, including 23 males and five females, aged from 9 to 58 years （average age of 35.2 years）. There were 19 cases of upper tibial defects, two cases of middle tibial defects, and seven cases of distal tibial defects. After open fracture operation, there were 17 cases of postoperative infections and 11 cases of postoperative infection and bone nonunion. All the patients were followed up for 6-30 months for wound and fracture healing. RESULTS AND CONCLUSION： Transplanted minimal morselized bone was covered with granulation tissue after postoperative 6 weeks, and wound was completely closed after postoperative 8 weeks. Two cases of poor facture healing achieved bone healing after secondary bone graft. The mean healing duration was 5 months. No neurovascular injury and drug susceptibility reaction occurred. These findings indicate that open autologous minimal morselized bone grafting with vancomycin is feasible to treat infected tibial defects.