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股骨远端慢性骨髓炎采用切除及延迟性假体置换重建术治疗：三例报告

Chronic Osteomyelitis of the Distal Femur Treated with Resection and Delayed Endoprosthetic Reconstruction: A Report of Three Cases.

作者信息

Ryan Sean, Eward William, Brigman Brian, Zura Robert

机构信息

Duke University Hospital, 1308 Mallory Lane, Durham, NC 27713, USA.

Duke University Hospital, 20 Duke Medicine Circle, Durham, NC 27710, USA.

出版信息

Case Rep Orthop. 2017;2017:5141032. doi: 10.1155/2017/5141032. Epub 2017 Aug 15.

DOI:10.1155/2017/5141032
PMID:28894615
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5574225/
Abstract

Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Stage one involved resection of infected bone and placement of an intramedullary nail spanning the bony defect between proximal femur and tibia, with antibiotic cement packed around the nail. Patients were then placed on long-term IV +/- oral antibiotics to clear the infection. A "cooldown" period was then used between stages where patients were off antibiotics and inflammatory markers were monitored for signs of remaining infection. Stage two then involved reconstruction of the distal femur and knee with an endoprosthesis. In the appropriate patient, this treatment strategy offers another option in this challenging population.

摘要

累及股骨远端的慢性骨髓炎常导致截肢或关节融合术。本文介绍了三例采用分期治疗方法治疗慢性骨髓炎的病例，最终进行了假体置换重建。第一阶段包括切除感染骨，并在股骨近端和胫骨之间跨越骨缺损处放置一枚髓内钉，髓内钉周围填充抗生素骨水泥。然后让患者接受长期静脉注射 +/- 口服抗生素治疗以清除感染。在两个阶段之间有一个“冷却期”，在此期间患者停用抗生素，并监测炎症标志物以寻找残留感染的迹象。第二阶段则使用假体对股骨远端和膝关节进行重建。对于合适的患者，这种治疗策略为这一具有挑战性的患者群体提供了另一种选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/eed46e951b4a/CRIOR2017-5141032.011.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/b86739aaac4d/CRIOR2017-5141032.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/fb90e3609c42/CRIOR2017-5141032.004.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/51d937550f7d/CRIOR2017-5141032.007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/21da221b28e0/CRIOR2017-5141032.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/d554454d4d38/CRIOR2017-5141032.002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/77ee069f4e71/CRIOR2017-5141032.006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/51d937550f7d/CRIOR2017-5141032.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/208e/5574225/3681f54fdab2/CRIOR2017-5141032.008.jpg
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