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儿童感染性胫骨骨不连:是否必须进行彻底清创?

Infected tibial nonunion in children: Is radical debridement mandatory?

作者信息

Hosny Gamal Ahmed, Ahmed Abdel-Salam Abdel-Aleem

机构信息

Benha University, Faculty of Medicine, Egypt.

出版信息

Injury. 2019 Feb;50(2):590-597. doi: 10.1016/j.injury.2018.10.043. Epub 2018 Oct 29.


DOI:10.1016/j.injury.2018.10.043
PMID:30391070
Abstract

UNLABELLED: Nonunion is a devastating complication of tibial fractures with a debilitating effect. Several studies reporting tibial nonunions in adults are available; however, the reports on infected nonunions in children are scarce. The purpose of this study was to evaluate the results of treating paediatric infected tibial nonunion using Ilizarov fixator without radical resection. MATERIALS AND METHODS: The study included 36 cases with infected nonunion of the tibia with 31 males and 5 females, and an average age of 11.4 years. The mean number of previous operations was 3.5. The duration before presentation averaged 10.4 months. At presentation, 24 cases were draining nonunions, while 12 patients had quiescent sinuses. Preoperative shortening was evident in 31 patients ranging from 1 to12 cm. Six cases had equinus foot deformity. Stiffness of the ankle and/or knee was present in 11 cases. Angular deformity of more than 10° was evident in 13 nonunions. The monofocal compression-distraction was used for 10 cases managed by bloodless technique, and four draining cases managed by limited debridement and compression distraction. Limited debridement and bone transport was used in the remaining cases including proximal chondrodiastasis (two cases), proximal tibial corticotomy (17 cases), and partial osteotomy (three cases). RESULTS: The mean follow-up duration was 51.9 months. The external fixation period averaged 5.3 months. Delayed union occurred in three cases treated by repeating compression-distraction. Eventually, union was achieved in all cases. Two cases suffered refracture. Four cases had residual angular deformity of about 5-7°. Infection recurred in one case. ASAMI bone results were excellent in 29 patients, good in three patients, fair in two patients, and poor in two patients. The ASAMI functional results were excellent in 27 cases, good in 5 cases, fair in two cases, and poor in two cases. CONCLUSION: The Ilizarov method provides a viable treatment method for treating paediatric infected nonunions in a single stage of management. Limited debridement was enough to control infection and achieved good results without radical resection.

摘要

未标注:骨不连是胫骨骨折的一种严重并发症,具有致残性。有几项关于成人胫骨骨不连的研究;然而,关于儿童感染性骨不连的报道却很少。本研究的目的是评估使用Ilizarov固定器在不进行根治性切除的情况下治疗儿童感染性胫骨骨不连的效果。 材料与方法:本研究纳入36例胫骨感染性骨不连患者,其中男性31例,女性5例,平均年龄11.4岁。既往手术的平均次数为3.5次。就诊前的平均病程为10.4个月。就诊时,24例为有窦道的骨不连,12例患者有静止性窦道。31例患者术前有明显短缩,范围为1至12厘米。6例有马蹄足畸形。11例存在踝关节和/或膝关节僵硬。13例骨不连有超过10°的角形畸形。10例采用单焦点加压-撑开术,采用无血技术处理,4例有窦道的病例采用有限清创和加压撑开术处理。其余病例采用有限清创和骨搬运,包括近端软骨撑开术(2例)、近端胫骨皮质切开术(17例)和部分截骨术(3例)。 结果:平均随访时间为51.9个月。外固定时间平均为5.3个月。3例采用重复加压-撑开术治疗的病例出现延迟愈合。最终,所有病例均实现骨愈合。2例发生再骨折。4例有大约5 - 7°的残余角形畸形。1例感染复发。ASAMI骨结果29例为优,3例为良,2例为可,2例为差。ASAMI功能结果27例为优,5例为良,2例为可,2例为差。 结论:Ilizarov方法为儿童感染性骨不连的单阶段治疗提供了一种可行的治疗方法。有限清创足以控制感染,无需根治性切除即可取得良好效果。

相似文献

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[2]
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引用本文的文献

[1]
Fracture nonunion and delayed union.

J Pediatr Soc North Am. 2024-4-9

[2]
Circular external fixation for revision of failed tibia internal fixation.

Eur J Orthop Surg Traumatol. 2024-1

[3]
International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100 birthday of G. A. Ilizarov).

World J Orthop. 2021-8-18

[4]
Pediatric aseptic lower leg fracture nonunion.

Eur J Trauma Emerg Surg. 2021-4

[5]
Management of Pediatric Tibial Nonunion following Osteotomy: A Case Series and Review of the Literature.

Case Rep Orthop. 2020-8-7

[6]
Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up.

Int Orthop. 2020-1-16

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