Herry Y, Reynaud O, Ferry T, Servien E, Neyret P, Lustig S
Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
Service de maladies infectieuses, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône-Alpes-Auvergne, hospices civils de Lyon, 69004 Lyon, France.
Orthop Traumatol Surg Res. 2017 Dec;103(8):1217-1220. doi: 10.1016/j.otsr.2017.09.011. Epub 2017 Sep 29.
The surgical treatment of septic non-union is challenging and carries a high failure rate. Bone defect management and fracture site stabilisation are key treatment objectives. We report the case of a 75-year-old woman who underwent intercalary endoprosthetic reconstruction of a large tibial defect due to septic non-union after two previous treatment failures. The two-stage procedure involved extensive excision of infected tissues and implantation of an antibiotic-loaded cement spacer followed by insertion of an intercalary endoprosthesis. Within only 2 months after the procedure, the patient was able to walk with no assistive device and no limp. After 12 months and 6 months after antibiotic discontinuation, the laboratory tests and imaging studies showed no evidence of infection. Intercalary endoprosthetic reconstruction may be a valid treatment option to avoid amputation for recurrent septic non-union, particularly in elderly patients.
感染性骨不连的外科治疗具有挑战性，且失败率很高。骨缺损处理和骨折部位稳定是关键治疗目标。我们报告了一例75岁女性患者的病例，该患者此前两次治疗失败后，因感染性骨不连接受了大段胫骨缺损的节段性内置假体重建术。两阶段手术包括广泛切除感染组织并植入载抗生素骨水泥间隔物，随后植入节段性内置假体。术后仅2个月，患者就能无需辅助器械行走且无跛行。停用抗生素12个月和6个月后，实验室检查和影像学研究均未显示感染迹象。节段性内置假体重建术可能是避免对复发性感染性骨不连进行截肢的有效治疗选择，尤其是在老年患者中。
