School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Orthop Clin North Am. 2024 Apr;55(2):233-246. doi: 10.1016/j.ocl.2023.09.005. Epub 2023 Oct 17.
Sequestration, a condition where a section of bone becomes necrotic due to a loss of vascularity or thrombosis, can be a challenging complication of osteomyelitis. This review explores the pathophysiology of sequestration, highlighting the role of the periosteum in forming involucrum and creeping substitution which facilitate revascularization and bone formation. The authors also discuss the induced membrane technique, a two-stage surgical procedure for cases of failed healing of sequestration. Future directions include the potential use of prophylactic anticoagulation and novel drugs targeting immunocoagulopathy, as well as the development of advanced imaging techniques and single-stage surgical procedures.
骨切开术，由于血管减少或血栓形成导致的骨节段坏死的一种情况，是骨髓炎的一种具有挑战性的并发症。这篇综述探讨了骨切开术的病理生理学，强调了骨膜在形成包壳和爬行替代物中的作用，这些有助于再血管化和骨形成。作者还讨论了诱导膜技术，这是一种针对骨切开术治疗失败的两阶段手术程序。未来的方向包括预防性抗凝和针对免疫性凝血病的新型药物的潜在用途，以及先进的成像技术和单阶段手术程序的发展。
