Dar Tahir A, Dhar Shabir A, Mir Naseer A, Maajid Saheel, Dar Reyaz A, Hussain Abid
Acta Orthop Belg. 2017 Dec;83(4):521-526.
The infected non union of the long bones in the presence of the intramedullary nail is a dreaded complication of fracture management. Around 7% patients may develop an infected non union of the long bones in intramedullary nailing. Amongst the various grades of infection, grade three infection is the most difficult to cure and manage as it involves an osteomyelitic bone. Amongst an array of therapeutic modalities, the two stage methods are commonly used with the first stage aimed at controlling the infection and the second stage at inducing union. This increases the number of surgical procedures. We used an Ilizarov threaded rod coated with antibiotic impregnated cement to replace the intramedullary nail with the idea of delivering higher concentration of antibiotic locally as well as provide stability. We achieved a union rate of 91% in a relatively small number of patients with this single procedure. The antibiotic impregnated cement coated Ilizarov rod that we used in our study achieves both infection control and union simultaneously and does not allow cement debonding at removal.
髓内钉固定后长骨感染性骨不连是骨折治疗中令人恐惧的并发症。约7%的患者在髓内钉固定后可能发生长骨感染性骨不连。在各种感染分级中,三级感染最难治愈和处理,因为它涉及骨髓炎骨。在一系列治疗方法中,两阶段方法常用,第一阶段旨在控制感染,第二阶段旨在促进骨愈合。这增加了手术次数。我们使用涂有抗生素浸渍骨水泥的伊利扎罗夫螺纹杆替代髓内钉,目的是在局部提供更高浓度的抗生素并提供稳定性。通过这一单一手术,我们在相对较少的患者中实现了91%的骨愈合率。我们在研究中使用的涂有抗生素浸渍骨水泥的伊利扎罗夫杆能同时实现感染控制和骨愈合,且在取出时不会出现骨水泥脱粘。