Steinlechner C W B, Mkandawire N C
Beit Trust CURE International Hospital, Blantyre, Malawi.
J Bone Joint Surg Br. 2005 Sep;87(9):1259-63. doi: 10.1302/0301-620X.87B9.15734.
The management of chronic osteomyelitis requires the excision of necrotic and infected material followed by the prolonged administration of antibiotics. Sequestrectomy may be required before an involucrum has formed, resulting in a longitudinal bone defect. This can be difficult to fill. Vascularised grafts are complicated by a high rate of recurrent infection and thrombosis. We have managed defects of long bones in children after sequestrectomy by the use of non-vascularised fibular grafts harvested subperiosteally and held by an intramedullary Kirschner wire. Eight children underwent this procedure. In six the tibia was involved and in one each the humerus and radius. One patient was lost to follow-up. Six grafts united at both ends within 12 weeks. The seventh developed an infected nonunion distally which united after further debridement. One patient required a further sequestrectomy which did not compromise union. We have found this to be a straightforward technique with reliable results and were able to salvage the limb in all the seven patients who were reviewed.
慢性骨髓炎的治疗需要切除坏死和感染组织，随后长期使用抗生素。在骨壳形成之前可能需要进行死骨切除术，这会导致纵向骨缺损，而这种缺损可能难以填补。带血管移植物存在反复感染和血栓形成的高发生率问题。我们采用经骨膜下采集的非带血管腓骨移植物并用髓内克氏针固定的方法，处理儿童死骨切除术后的长骨缺损。8名儿童接受了此手术。其中6名患儿的胫骨受累，1名患儿的肱骨和桡骨各有1例受累。1例患者失访。6例移植物在12周内两端均愈合。第7例患者远端出现感染性骨不连，经进一步清创后愈合。1例患者需要再次进行死骨切除术，但这并未影响骨愈合。我们发现这是一种简单明了的技术，结果可靠，并且在所复查的7例患者中均成功保住了肢体。
