Makridis Kostas G, Tosounidis Theodoros, Giannoudis Peter V
Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, LS1 3EX Leeds, UK.
Open Orthop J. 2013 Jun 14;7:219-26. doi: 10.2174/1874325001307010219. Print 2013.
Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.
植入物相关脓毒症是长骨骨折髓内钉固定相对少见的并发症。根据感染程度、诊断时机及骨折愈合进程，已制定了不同的治疗策略。这篇综述文章的目的是收集并分析关于长骨骨折髓内钉固定术后感染发生率及处理的现有证据，并推荐在日常临床实践中可能有价值的治疗方案。在检索PubMed/Medline数据库后，发现过去20年中有1270篇与该主题相关的文章。最终纳入综述的有28篇符合纳入标准的文章。仅有少数前瞻性研究报道过长骨骨折髓内钉固定术后感染的处理。一般来说，I期（早期）感染仅需使用或不使用清创术的抗生素治疗。II期（延迟）感染可通过清创术、髓腔再扩髓、抗生素骨钉及抗生素给药成功治疗。感染性骨不连最好采用更换髓内钉、抗生素给药治疗，若有必要，在感染根除后进行植骨。清创术、更换髓内钉及全身性抗生素给药是III期（晚期）感染的最佳治疗方法，而III期感染性骨不连可通过取出髓内钉及使用伊里扎洛夫架成功治疗，尤其是存在大的骨缺损时。
