[1]刘兵,马翔宇,杨超,等.替加环素骨水泥涂层髓内钉固定结合膜诱导技术治疗革兰氏阴性杆菌所致胫骨干感染性骨缺损[J].中医正骨,2020,32(09):66-69.
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替加环素骨水泥涂层髓内钉固定结合膜诱导技术治疗革兰氏阴性杆菌所致胫骨干感染性骨缺损()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年09期
页码:
66-69
栏目:
临床报道
出版日期:
2020-09-20

文章信息/Info

作者:
刘兵马翔宇杨超解冰周大鹏
(中国人民解放军北部战区总医院,辽宁 沈阳 110016)
关键词:
胫骨骨折 感染 骨缺损 膜诱导技术 抗菌药 替加环素 骨水泥 革兰氏阴性杆菌
摘要:
目的:探讨替加环素骨水泥涂层髓内钉固定结合膜诱导技术治疗革兰氏阴性杆菌所致胫骨干感染性骨缺损的临床疗效与安全性。方法:2017年2月至2019年2月收治14例革兰氏阴性杆菌所致胫骨干感染性骨缺损患者。男8例,女6例。年龄27~69岁,中位数45.5岁。原始胫骨损伤包括开放性骨折9例、闭合性骨折5例。初次骨折固定方式包括髓内钉固定6例、接骨板固定5例、外固定架固定3例。骨折至本次手术时间4~15个月,中位数10个月。均伴有窦道形成、皮肤软组织缺损或骨外露。均不合并精神疾病、代谢性骨病、严重营养不良以及其他部位骨折。窦道分泌物细菌培养结果,大肠埃希菌4例、铜绿假单胞菌3例、阴沟肠杆菌3例、鲍曼不动杆菌2例、肺炎克雷伯菌2例。采用替加环素骨水泥涂层髓内钉固定结合膜诱导技术治疗,第1阶段手术行清创、替加环素骨水泥涂层髓内钉固定及骨缺损部位抗生素骨水泥填充,第2阶段手术取出骨水泥并以自体髂骨松质骨、皮质骨混合骨水泥移植。随访观察感染控制、骨愈合及并发症发生情况,采用Johner-Wruhs胫骨干骨折疗效评价标准评价临床疗效。结果:清创后胫骨干骨缺损长度(5.2±1.2)cm,细菌培养结果均为阴性。第1阶段手术后,感染均得到控制。所有患者均获得随访,随访时间12~24个月,中位数18个月。骨缺损均骨性愈合,愈合时间4.5~9个月,中位数5.5个月。末次随访时,根据Johner-Wruhs胫骨干骨折疗效评价标准,优8例、良4例、中2例。2例患者第1阶段手术后出现切口皮缘组织部分坏死,经换药处理后切口均顺利愈合。3例患者出现踝关节前方长伸肌螺钉激惹症状,取出内固定后症状均消失; 均无感染复发、内固定失效等并发症发生。结论:替加环素骨水泥涂层髓内钉固定结合膜诱导技术治疗革兰氏阴性杆菌所致胫骨干感染性骨缺损,能有效控制感染,有利于骨折愈合和患肢功能恢复,且安全性高。

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备注/Memo

备注/Memo:
基金项目:辽宁省自然科学基金指导计划项目(20180550361)
通讯作者:周大鹏 E-mail:me3210@163.com
更新日期/Last Update: 2020-09-20