Li Meng, Lan Xu, Zeng Ping, Li Zhiling, Gao Qiuming, Gao Jie
Department of Orthopaedic Trauma, Lanzhou General Hospital of Lanzhou Military District, Lanzhou Gansu, 730050,
Department of Orthopaedic Trauma, Lanzhou General Hospital of Lanzhou Military District, Lanzhou Gansu, 730050, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Jan 15;32(1):25-30. doi: 10.7507/1002-1892.201707107.
To investigate the effectiveness on the re-fracture of the femur with occult infection by using non-contact locking plate which was placed under the deep fascia.
Clinical data of 12 cases of occult infective re-fracture after femoral fracture operation were retrospectively analysed between January 2010 and December 2014. There were 8 males and 4 females with an age of 28-69 years (mean, 42.8 years). Femur re-fractured in 5 cases after 3 days to 4 weeks (mean, 10.6 days) of removal of internal fixation, including 4 cases of plate fixation and 1 case of intramedullary nail fixation; femur in 7 cases re-fractured because of breakage of internal fixator after 7-16 months (mean, 9.3 months) of internal fixation, including 5 cases of plate fixation and 2 cases of intramedullary nail fixation. The tissues near the fracture were collected for bacteria culturing and pathological examining. All the patients were treated by debriding the site of the fracture, bridging with the non-contact locking plate, and transplanting with granulated cancellous bone autograft. Intravenous infusion of antibiotics were used for 2-3 weeks after operation and oral administration for 4 weeks. The X-ray films were taken regularly and the function of the knees were evaluated by the Hospital for Special Surgery (HSS) score system.
The results of bacteria culturing were positive in 8 patients and negative in 4 patients, and the pathological results of all the patients were confirmed to be chronic bone infection. All the fractures healed with no signs of exudation and ulceration of the incisions. The 12 patients were followed up 18-36 months (mean, 29.6 months). The fracture healed well and no re-fracture occurred. The fracture healing time was 14-22 weeks (mean, 18 weeks). At last follow-up, the function of the knee joint was excellent in 9 cases and good in 3 cases according to HSS score system.
The treatment of re-fractures after femur fracture operation needs to determine whether there is an occult infection, and non-contact locking plate placed under the deep fascia is an effective way for the re-fracture.
探讨采用置于深筋膜下的非接触锁定钢板治疗合并隐匿感染的股骨再骨折的疗效。
回顾性分析2010年1月至2014年12月间12例股骨骨折术后隐匿感染性再骨折患者的临床资料。其中男8例，女4例，年龄28 - 69岁（平均42.8岁）。5例在取出内固定3天至4周（平均10.6天）后发生股骨再骨折，其中钢板固定4例，髓内钉固定1例；7例在进行内固定7 - 16个月（平均9.3个月）后因内固定器断裂发生股骨再骨折，其中钢板固定5例，髓内钉固定2例。采集骨折部位附近组织进行细菌培养及病理检查。所有患者均行骨折部位清创、采用非接触锁定钢板桥接及自体松质骨颗粒移植治疗。术后静脉输注抗生素2 - 3周，口服抗生素4周。定期拍摄X线片，并采用特种外科医院（HSS）评分系统评估膝关节功能。
细菌培养结果8例阳性，4例阴性，所有患者病理结果均确诊为慢性骨感染。所有骨折均愈合，切口无渗出及溃疡迹象。12例患者随访18 - 36个月（平均29.6个月）。骨折愈合良好，未发生再骨折。骨折愈合时间为14 - 22周（平均18周）。末次随访时，根据HSS评分系统，膝关节功能优9例，良3例。
股骨骨折术后再骨折的治疗需确定是否存在隐匿感染，置于深筋膜下的非接触锁定钢板是治疗再骨折的有效方法。
