股骨远端感染性骨不连行内固定取出及骨移植术后腿部皮下气肿
Subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur.
作者信息
Denaro Vincenzo, Longo Umile Giuseppe, Salvatore Giuseppe, Candela Vincenzo, Maffulli Nicola
机构信息
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
出版信息
BMC Musculoskelet Disord. 2017 Aug 15;18(1):351. doi: 10.1186/s12891-017-1706-y.
BACKGROUND
Infected non-unions of the supracondylar region of the femur are uncommon. Even though hardware removal is a common procedure, it may lead to complications, including neurovascular injury, refracture, worsening pain or recurrence of deformity.
CASE PRESENTATION
We report on a male who developed subcutaneous emphysema of the leg after hardware removal and bone allografting for an infected non-union of the distal femur. He was managed by debridement of the surgical wound, antibiotic therapy, multiple fasciotomies, and application of a VAC (vacuum-assisted closure) system.
CONCLUSIONS
Although subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur is extremely rare, the potential life treating complications and their potential impact on the functional status of the patient have to be taken into consideration when counseling patients about this procedure. Even when it is not possible to identify a bacterial pathogen responsible for the subcutaneous emphysema of the leg, prompt intervention may save the limb of the patient.
背景
股骨髁上区域的感染性骨不连并不常见。尽管取出内固定是一种常见的手术，但可能会导致并发症，包括神经血管损伤、再骨折、疼痛加重或畸形复发。
病例报告
我们报告一名男性，在因股骨远端感染性骨不连进行内固定取出和骨移植后出现了小腿皮下气肿。他接受了手术伤口清创、抗生素治疗、多次筋膜切开术以及应用VAC（负压封闭引流）系统治疗。
结论
尽管因股骨远端感染性骨不连进行内固定取出和骨移植后出现小腿皮下气肿极为罕见，但在向患者咨询该手术时，必须考虑到潜在的危及生命的并发症及其对患者功能状态的潜在影响因素。即使无法确定导致小腿皮下气肿的细菌病原体，及时干预也可能挽救患者的肢体。
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