Luo Fei, Wang Xiaohua, Wang Shulin, Fu Jingshu, Xie Zhao
National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China.
Injury. 2017 Jul;48(7):1623-1627. doi: 10.1016/j.injury.2017.04.052. Epub 2017 Apr 26.
The purpose of this study was to observe the effects of induced membrane technique combined with two-stage internal fixation in the treatment of tibial osteomyelitis defects.
A retrospective analyses for 67 cases of tibialosteomyelitis defects were admitted to our department between September 2012 to February 2015, which were treated with induced membrane technique. At the first stage, implanted with a PMMA cement spacer in the defects after radical debridement and fixed with reconstructive locked plate. Bone grafting and exchanged the plate with intramedullary nail at the second stage.
In current study, all patients were followed up for 18-35 months. Sixty-six patients achieved bone union with the average radiographic and clinical healing times of 5.55±2.19 and 7.45±1.69months, respectively. Seven patients required a second debridement before grafting, while four patients experienced a recurrence of infection or a relapse following second stage treatment. Twelve patients experienced either knee or ankle dysfunctions and 2 patients faced delayed wound healing. Donor site complications includes pain and infection were found in 7 and 3 patients, respectively with delayed stress fracture in 1 patient only.
Induced membrane technique for the treatment of tibial osteomyelitis defects, seems a reliable method. The use of reconstructive locked plate as a temporary internal fixation at the first stage and exchanged with intramedullary nail at the second stage, potentially achieves good clinical efficacy. Care should be taken to restore the joint function especially in distal tibia.
本研究旨在观察诱导膜技术联合两阶段内固定治疗胫骨骨髓炎骨缺损的效果。
回顾性分析2012年9月至2015年2月期间收治于我科的67例胫骨骨髓炎骨缺损患者，均采用诱导膜技术治疗。第一阶段，在彻底清创后于缺损处植入聚甲基丙烯酸甲酯（PMMA）骨水泥间隔物，并用重建锁定钢板固定。第二阶段进行植骨并将钢板更换为髓内钉。
在本研究中，所有患者均随访18 - 35个月。66例患者实现骨愈合，平均影像学愈合时间和临床愈合时间分别为5.55±2.19个月和7.45±1.69个月。7例患者在植骨前需要再次清创，4例患者在第二阶段治疗后出现感染复发或病情反复。12例患者出现膝关节或踝关节功能障碍，2例患者伤口愈合延迟。供区并发症包括疼痛和感染，分别有7例和3例患者出现，仅1例患者发生延迟性应力性骨折。
诱导膜技术治疗胫骨骨髓炎骨缺损似乎是一种可靠的方法。第一阶段使用重建锁定钢板作为临时内固定，第二阶段更换为髓内钉，有可能取得良好的临床疗效。尤其在胫骨远端，应注意恢复关节功能。
