Kawakami Ryoichi, Ejiri Soichi, Hakozaki Michiyuki, Hatashita Satoshi, Sasaki Nobuyuki, Kobayashi Yoshitaka, Takahashi Yoko, Konno Shin-Ichi
Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University School of Medicine.
Fukushima J Med Sci. 2016 Dec 16;62(2):83-89. doi: 10.5387/fms.2016-5. Epub 2016 Jul 30.
The treatment of septic non-union of the tibia is a challenging area. The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin.
PATIENTS & METHOD: Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled. The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm. A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later. Vascular anastomosis was performed with the flow-through technique in all patients. Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week.
Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus.
Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia.
胫骨感染性骨不连的治疗是一个具有挑战性的领域。本临床研究的目的是通过包括两阶段手术、游离血管化腓骨移植（FVFG）的血管吻合的通流技术以及持续局部动脉内输注肝素这三种策略，改善感染高度活跃患者的治疗效果。
纳入5例接受FVFG治疗的胫骨感染性骨不连患者（平均年龄：52.8岁）。术后平均随访期为47.2个月，骨缺损平均长度为111mm。采用两阶段手术，先将含抗生素的聚甲基丙烯酸甲酯（PMMA）珠粒植入骨缺损，随后再用FVFG进行骨重建。所有患者均采用通流技术进行血管吻合。FVFG术后立即通过股动脉导管持续输注肝素1周。
所有患者术后平均18.8周确认骨愈合，无需因血栓再次手术。
我们应用这些策略的尝试似乎是治疗胫骨感染性骨不连的一种可行选择。
