Guo Xiaofeng, Xue Mingyu, Deng Xinxin, Huang Zhihu, Bu Fanyu
Department of Wound Repair, Wuxi Ninth People's Hospital, Wuxi Jiangsu, 214000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Feb 15;37(2):153-156. doi: 10.7507/1002-1892.202207133.
To investigate the effectiveness of homemade antibiotic bone cement rod in the treatment of tibial screw canal osteomyelitis by Masquelet technique.
A clinical data of 52 patients with tibial screw canal osteomyelitis met the criteria between October 2019 and September 2020 was retrospectively analyzed. There were 28 males and 24 females, with an average age of 38.6 years (mean, 23-62 years). The tibial fractures were treated with internal fixation in 38 cases and external fixation in 14 cases. The duration of osteomyelitis was 6 months to 20 years with a median of 2.3 years. The bacterial culture of wound secretions showed 47 positive cases, of which 36 cases were infected with single bacteria and 11 cases were infected with mixed bacteria. After thorough debridement and removal of internal and external fixation devices, the locking plate was used to fixed the bone defect. The tibial screw canal was filled with the antibiotic bone cement rod. The sensitive antibiotics were given after operation and the 2nd stage treatment was performed after infection control. The antibiotic cement rod was removed and the bone grafting in the induced membrane was performed. After operation, the clinical manifestations, wound, inflammatory indexes, and X-ray films were monitored dynamically, and the postoperative bone infection control and bone graft healing were evaluated.
Both patients successfully completed the two stages of treatments. All patients were followed up after the 2nd stage treatment. The follow-up time was 11 to 25 months (mean, 18.3 months). One patient had poor wound healing and the wound healed after enhanced dressing change. X-ray film showed that the bone grafting in the bone defect healed and the healing time was 3-6 months, with an average of 4.5 months. The patient had no recurrence of infection during the follow-up period.
For the tibial screw canal osteomyelitis, the homemade antibiotic bone cement rod can reduce the recurrence rate of infection and obtain a good effectiveness, and has the advantages of simple operation and less postoperative complications.
探讨自制抗生素骨水泥棒在Masquelet技术治疗胫骨螺钉孔骨髓炎中的有效性。
回顾性分析2019年10月至2020年9月期间52例符合标准的胫骨螺钉孔骨髓炎患者的临床资料。其中男性28例，女性24例，平均年龄38.6岁（23 - 62岁）。胫骨骨折采用内固定治疗38例，外固定治疗14例。骨髓炎病程6个月至20年，中位数为2.3年。伤口分泌物细菌培养47例阳性，其中单菌感染36例，混合菌感染11例。彻底清创并去除内、外固定装置后，采用锁定钢板固定骨缺损。胫骨螺钉孔内填充抗生素骨水泥棒。术后给予敏感抗生素，感染控制后进行二期治疗。取出抗生素骨水泥棒，在诱导膜内行植骨术。术后动态监测临床表现、伤口、炎症指标及X线片，评估术后骨感染控制及植骨愈合情况。
所有患者均成功完成两阶段治疗。二期治疗后全部患者均获随访，随访时间11至25个月（平均18.3个月）。1例患者伤口愈合不佳，加强换药后伤口愈合。X线片显示骨缺损处植骨愈合，愈合时间3 - 6个月，平均4.5个月。随访期间患者无感染复发。
对于胫骨螺钉孔骨髓炎，自制抗生素骨水泥棒可降低感染复发率，疗效良好，且具有操作简单、术后并发症少的优点。
