Department of Orthopaedics and Traumatology, Guangdong second provincial general hospital, The Second Clinical Medical School of Southern Medical University, Guangzhou, 510317, P.R. China.
Department of Orthopaedics, Nanfang Hospital, Division of Orthopaedics and traumatology, Southern Medical University, Guangzhou, 510515, P.R. China.
BMC Musculoskelet Disord. 2020 Oct 28;21(1):710. doi: 10.1186/s12891-020-03734-z.
The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis.
We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed.
A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively.
Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.
随着髓内固定在长骨骨折中的应用日益增多，髓内感染的发病率也在增加。然而，对于髓内钉术后感染的治疗尚不清楚。本研究旨在报告我们治疗髓内钉术后感染的方案结果：髓内钉取出、局部清创、扩髓冲洗、载抗生素硫酸钙植入，必要时行骨段切除和骨搬移。
我们回顾性分析了 2014 年至 2017 年在我院治疗的髓内钉术后感染患者的病历。排除随访时间少于 24 个月、接受其他治疗方法或患有严重疾病的患者。符合标准的患者采用上述方法治疗，9 例患者采用骨搬移修复骨缺损。评估感染缓解率、感染复发率和术后并发症发生率。
共纳入 19 例患者进行分析。所有患者平均随访 38.1±9.4 个月（24 至 55 个月），均获得满意疗效。18 例（94.7%）患者感染得到缓解；1 例（5.3%）患者出现再感染，经再次清创后治愈。9 例骨缺损患者（平均缺损大小 4.7±1.3cm；范围 3.3 至 7.6cm）采用骨搬移治疗，成功恢复了受累肢体的长度。平均骨搬移时间为 10.7±4.0 个月（6.7 至 19.5 个月）。大多数患者在随访期间能够完全负重，且疼痛缓解。术后并发症主要包括长期无菌引流（7/19；36.8%）、再骨折（1/19；5.3%）和关节僵硬，分别通过定期换药和重新固定成功处理。
髓内钉取出、髓腔扩锉和冲洗、载抗生素硫酸钙植入（必要时行骨搬移）是治疗髓内钉术后感染的有效方法。
