Paley Dror, Herzenberg John E
Rubin Institute for Advanced Orthpaedics, International Center for Limb Lengthening, Baltimore, Maryland 21215, USA.
J Orthop Trauma. 2002 Nov-Dec;16(10):723-9. doi: 10.1097/00005131-200211000-00007.
The treatment of intramedullary infections after nailing usually includes removal of the rod, debridement of the canal, and, in many cases, insertion of antibiotic-impregnated cement beads. These beads offer no mechanical support and are difficult to remove if left in place for more than 2 weeks. We present an alternative for filling the medullary canal's noncollapsible dead space with an antibiotic-impregnated cement rod. This rod can be custom-made at the time of surgery, using different diameter chest tubes as molds and embedding a 3-mm beaded guidewire within the cement. The smooth molded surface of this nail makes extraction of the cement rod relatively easy. The cement rod also provides some limited temporary support to the fracture or nonunion site while the infection is being treated. After 6 weeks, the rod can be removed and replaced with a definitive metal intramedullary nail, with or without bone grafting to treat the previously infected fracture or nonunion site. We retrospectively reviewed nine cases of intramedullary infection treated with antibiotic-impregnated molded cement rods. These included six femora, two tibiae, and one humerus. The cause of infection was lengthening or transport over nail in six cases, fixator-augmented nailing of osteotomies in two, and fracture fixation in one. The follow-up period after surgery ranged from 38 to 48 months. No recurrent infection occurred during this follow-up period, and no patient required antibiotics after the rod was removed. In all cases, the canal cultures were negative after rod removal. The cement rod was removed between 29 and 753 days after implantation. Fracture of the rod occurred in one case in which the rod was left in place for more than 1 year. We conclude that this method is a relatively simple and inexpensive alternative for the treatment of intramedullary infections.
髓内钉固定术后髓内感染的治疗通常包括取出髓内钉、清创髓腔，并且在许多情况下，要植入含抗生素的骨水泥珠链。这些骨水泥珠链不提供机械支撑，如果留置超过2周则很难取出。我们提出一种替代方法，即用含抗生素的骨水泥棒填充髓腔不可塌陷的死腔。这种骨水泥棒可在手术时定制，使用不同直径的胸管作为模具，并在骨水泥内嵌入一根3毫米带珠导丝。这种骨水泥棒光滑的成型表面使得取出骨水泥棒相对容易。在治疗感染时，骨水泥棒还能为骨折或骨不连部位提供一定限度的临时支撑。6周后，可以取出骨水泥棒，并用确定性金属髓内钉替换，如果需要，可同时进行植骨以治疗先前感染的骨折或骨不连部位。我们回顾性分析了9例采用含抗生素的成型骨水泥棒治疗的髓内感染病例。其中包括6例股骨、2例胫骨和1例肱骨。感染原因包括6例髓内钉延长或跨越髓内钉转运、2例截骨术的固定器辅助髓内钉固定以及1例骨折固定。术后随访时间为38至48个月。在此随访期间未发生复发性感染，取出骨水泥棒后没有患者需要使用抗生素。在所有病例中，取出骨水泥棒后髓腔培养均为阴性。骨水泥棒在植入后29至753天取出。1例骨水泥棒留置超过1年的病例发生了骨水泥棒断裂。我们得出结论，这种方法是治疗髓内感染的一种相对简单且经济的替代方法。
