Esterhai J L, Sennett B, Gelb H, Heppenstall R B, Brighton C T, Osterman A L, LaRossa D, Gelman H, Goldstein G
Department of Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104.
J Trauma. 1990 Jan;30(1):49-54. doi: 10.1097/00005373-199001000-00008.
Forty-two consecutive patients with chronic osteomyelitis complicating persistent tibial nonunion and chronic osteomyelitis complicating tibial fracture with segmental bone loss were treated from January 1979 through December 1986 using a protocol including either open cancellous bone grafting (Friedlaender-Papineau technique), posterolateral bone grafting (Harmon technique), or local or microvascular soft-tissue transfer before cancellous bone grafting. Each patient had undergone surgical debridement and intravenous antibiotic therapy before inclusion in this study. Patients were classified using a staging system which included consideration of anatomic location of the infection within the bone; extent of bone involvement; quality of soft-tissue envelope and vascular integrity; and generalized host status. The overall success rate for arresting the osteomyelitis and healing the nonunion was 62% (26/42). If the six patients who refused additional bone graft surgery, the one patient who represented poor patient selection, and the patient who refused ankle arthrodesis are eliminated, the success rate for healing of the nonunion and resolving the osteomyelitis in this difficult patient population is: open bone cell graft, 66% (12/18); soft-tissue transfer 87.5%, (7/8); and posterolateral bone grafting, 87.5% (7/8). Use of a standardized classification system allows comparison of treatment results. Adequate debridement is crucial in treating osteomyelitis complicating established long bone fractures and nonunions. Determining the extent of debridement has proven to be the single most difficult aspect technically. Patient selection and pretreatment education are crucial. Caring for these patients is not only labor intensive and demanding of personnel and hospital resources, but demanding of the patients as well.
1979年1月至1986年12月期间，连续42例慢性骨髓炎合并持续性胫骨骨不连以及慢性骨髓炎合并胫骨骨折伴节段性骨缺损的患者接受了治疗，治疗方案包括开放性松质骨植骨（弗里德兰德 - 帕皮诺技术）、后外侧骨移植（哈蒙技术），或在松质骨植骨前进行局部或微血管软组织转移。在纳入本研究之前，每位患者均已接受手术清创和静脉抗生素治疗。患者采用一种分期系统进行分类，该系统包括考虑骨内感染的解剖位置；骨受累程度；软组织包膜质量和血管完整性；以及全身宿主状况。控制骨髓炎和治愈骨不连的总体成功率为62%（26/42）。如果排除6例拒绝额外骨移植手术的患者、1例患者选择不当的患者以及1例拒绝踝关节融合术的患者，在这一困难患者群体中骨不连愈合和骨髓炎消退的成功率为：开放性骨细胞移植，66%（12/18）；软组织转移，87.5%（7/8）；后外侧骨移植，87.5%（7/8）。使用标准化分类系统可以比较治疗结果。充分清创对于治疗合并陈旧性长骨骨折和骨不连的骨髓炎至关重要。确定清创范围在技术上已被证明是最困难的一个方面。患者选择和预处理教育至关重要。护理这些患者不仅劳动强度大，对人员和医院资源要求高，对患者本身的要求也很高。
