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一期手术成功治疗粗隆下股骨骨折合并术后慢性骨髓炎:病例报告

Subtrochanteric femoral fracture with postoperative chronic osteomyelitis treated successfully by 1-stage operation: a case report.

作者信息

Chi Genying, Ren Haiyong, Lin Bingyuan, Huang Kai

机构信息

Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China.

出版信息

Ann Transl Med. 2021 Mar;9(6):514. doi: 10.21037/atm-21-413.

Abstract

Chronic osteomyelitis is a chronic infectious disease of bone tissue, which can cause necrosis of bone and surrounding soft tissue, and is a common complication of open fracture, internal fixation, diabetic foot and blood-borne bone infection. Traumatic osteomyelitis is caused by bone tissue infection after open fracture surgery or open reduction of fracture or other bone and joint surgery. The lesion is near the fracture end. Intramedullary infection is the most serious infection in acute stage, with high fever, chills and other toxemia symptoms, similar to acute hematogenous osteomyelitis. The other is the skin and muscle necrosis infection near the fracture, which makes Fractures that lose blood supply are exposed to air and become dry and necrotic, and the course of disease turns to chronic, often accompanied by infectious nonunion or bone damage. The course of disease is prolonged and the treatment is difficult. Subtrochanteric femoral fracture with postoperative chronic osteomyelitis is a rare condition requiring complex treatment. In the present study, we report on a 49-year-old male patient who received open reduction with intramedullary nail fixation due to subtrochanteric femoral fracture, but later suffered postoperative infection and developed chronic osteomyelitis. On the basis of the complete removal of the osteomyelitis lesion, we performed a 1-stage operation where free vascularized fibula was used to repair the bone defect, followed by effective internal fixation. The patient was followed up for 24 months and finally recovered from chronic osteomyelitis, with good functional recovery of the hip joint and a Harris score of 85.

摘要

慢性骨髓炎是一种骨组织的慢性感染性疾病,可导致骨质及周围软组织坏死,是开放性骨折、内固定、糖尿病足及血源性骨感染的常见并发症。创伤性骨髓炎是由开放性骨折手术、骨折切开复位或其他骨关节手术后的骨组织感染引起的。病变位于骨折端附近。髓内感染是急性期最严重的感染,伴有高热、寒战等毒血症症状,类似于急性血源性骨髓炎。另一种是骨折附近的皮肤和肌肉坏死感染,使失去血供的骨折端暴露于空气中,变得干燥坏死,病程转为慢性,常伴有感染性骨不连或骨缺损。病程迁延,治疗困难。股骨转子下骨折术后并发慢性骨髓炎是一种罕见的情况,需要复杂的治疗。在本研究中,我们报告了一名49岁男性患者,因股骨转子下骨折接受切开复位髓内钉固定,但术后发生感染并发展为慢性骨髓炎。在彻底清除骨髓炎病灶的基础上,我们进行了一期手术,采用游离带血管腓骨修复骨缺损,随后进行有效的内固定。对患者进行了24个月的随访,最终慢性骨髓炎治愈,髋关节功能恢复良好,Harris评分为85分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d59d/8039705/197601b693ea/atm-09-06-514-f1.jpg

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