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创伤后髌骨骨髓炎合并耐甲氧西林金黄色葡萄球菌感染及膝关节僵硬的治疗:1 例报告。

Treatment of posttraumatic patella osteomyelitis with MRSA infection and knee stiffness: a case report.

机构信息

Department of Orthopedics, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China.

Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China.

出版信息

BMC Surg. 2020 Dec 7;20(1):320. doi: 10.1186/s12893-020-00996-1.

Abstract

BACKGROUND

Posttraumatic patella osteomyelitis is rare, and the treatment of osteomyelitis remains to be challenging. Control of the infection commonly costs a long time, and it is easily to cause knee stiffness. In addition, there is no unified protocol for the treatment of knee stiffness.

CASE PRESENTATION

We reported a case of posttraumatic patella osteomyelitis that successive infected with methicillin-resistant staphylococcus aureus (MRSA) after multiple surgeries. We successfully treated osteomyelitis by one-staged surgery, but the patient present knee stiffness after treatment. Thus Ilizarov external fixation system was further used to gradually adjust the mobility by exerting mechanical stress to the joint. After adjusting the frame under a scheduled plan, the patient successfully restored satisfactory knee function.

CONCLUSIONS

Adequate debridement is the key to control infections of posttraumatic osteomyelitis. Control the infection of posttraumatic patella osteomyelitis by one-staged surgery is achievable and could shorten the knee immobilization period. When knee stiffness occurs, scheduled range of motion (ROM) adjustment using Ilizarov frame with hinges might be a safe and useful method to restore function.

摘要

背景

创伤后髌骨骨髓炎较为罕见,骨髓炎的治疗仍然具有挑战性。通常需要很长时间来控制感染,并且容易导致膝关节僵硬。此外,对于膝关节僵硬的治疗还没有统一的方案。

病例介绍

我们报告了一例创伤后髌骨骨髓炎的病例,该患者在多次手术后相继感染耐甲氧西林金黄色葡萄球菌(MRSA)。我们通过一期手术成功治愈了骨髓炎,但治疗后患者出现膝关节僵硬。因此,进一步使用伊利扎洛夫外固定系统通过对关节施加机械应力来逐渐调整关节活动度。在按计划调整框架后,患者成功恢复了满意的膝关节功能。

结论

充分清创是控制创伤后骨髓炎感染的关键。一期手术控制创伤后髌骨骨髓炎的感染是可行的,可以缩短膝关节固定时间。当发生膝关节僵硬时,使用带有铰链的伊利扎洛夫框架进行有计划的关节活动度(ROM)调整可能是恢复功能的一种安全有效的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72be/7722441/de3dd0bd1990/12893_2020_996_Fig1_HTML.jpg

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