Wang Shangzeng
Department of Orthopedics, Second Affiliated Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou Henan 450002, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):972-5.
To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyelitis and nonunion of bone caused by intramedullary fixation.
Between June 2002 and May 2006, 12 patients with chronic osteomyelitis and nonunion of bone caused by intramedullary nailing were treated, including 8 males and 4 females with an average age of 40.2 years (range, 26-53 years). The fracture locations included tibia in 7 cases and femur in 5 cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months (range, 1-24 months). The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyelitis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months.
All wounds healed by first intention without early complication. All cases were followed up 24 to 48 months (mean, 34 months). WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture healing at 10-14 weeks after operation (mean, 12 weeks). Expect one patient had knee range of motion of 90 degrees, the lower limb function of the others returned to normal. No infection recurred during follow-up.
Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nailing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effective and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nailing.
探讨抗生素骨水泥临时间隔器治疗髓内固定术后骨髓炎及骨不连的疗效。
2002年6月至2006年5月，对12例髓内钉固定术后慢性骨髓炎及骨不连患者进行治疗，其中男性8例，女性4例，平均年龄40.2岁（26 - 53岁）。骨折部位：胫骨7例，股骨5例。7例感染发生在髓内固定术后2周内，5例发生在3个月内。感染至入院的平均时间为5个月（1 - 24个月）。细菌培养结果10例阳性，2例阴性。白细胞（WBC）计数、红细胞沉降率（ESR）及C反应蛋白（CRP）均高于正常值。在去除生物膜和内固定器、彻底清创冲洗后，植入抗生素骨水泥临时间隔器。术后经抗生素治疗控制骨髓炎后，3至6个月行二期植骨及内固定。
所有伤口均一期愈合，无早期并发症。所有病例随访24至48个月（平均34个月）。术后3个月时WBC计数、ESR及CRP均恢复正常。X线片显示术后10 - 14周（平均12周）骨折愈合。除1例患者膝关节活动度为90度外，其余患者下肢功能均恢复正常。随访期间无感染复发。
抗生素骨水泥临时间隔器可控制髓内钉固定术后骨髓炎及骨不连，骨髓炎控制后二期植骨及内固定是治疗髓内钉固定术后骨髓炎及骨不连的有效且理想的方法。
