Patzakis M J, Scilaris T A, Chon J, Holtom P, Sherman R
University of Southern California, School of Medicine, Los Angeles 90033, USA.
Clin Orthop Relat Res. 1995 Jun(315):192-8.
Thirty-two patients with infected tibial nonunions were treated, including 24 men and 8 women whose ages ranged from 21 to 72 years (mean, 40 years). Thirty of 32 patients had bone defects < 3 cm. Using the Cierney-Mader classification of osteomyelitis, 11 of 32 (35%) patients were Stage 4A, and 21 of 32 (65%) patients were Stage 4B. All patients had irrigation, debridement, and stabilization using an external fixation device. Twenty-seven (84%) patients had muscle transfers. The time between initial debridement and muscle transfer ranged from 3 to 24 days (mean, 4 days). Bone grafting was performed between 6 weeks and 8 months (mean, 8 weeks) after soft tissue coverage. Patients received intravenous antibiotics for 2 to 6 weeks (mean, 6 weeks). Twenty patients received anterior grafting, 10 received posterolateral grafting, and 2 received both. Followup times ranged from 12 to 49 months (mean, 28 months). Twenty-nine of the 32 (91%) patients had tibial unions between 3 to 10 months (mean, 5.5 months) after bone grafting. The 3 failed tibias united after posterolateral grafting. Infection was controlled in all 32 patients. Autogenous cancellous bone grafting using infection control principles is an effective means to treat infected tibial nonunions.
对32例感染性胫骨骨不连患者进行了治疗，其中男性24例，女性8例，年龄21至72岁（平均40岁）。32例患者中有30例骨缺损<3 cm。根据Cierney-Mader骨髓炎分类，32例患者中有11例（35%）为4A期，21例（65%）为4B期。所有患者均采用外固定装置进行冲洗、清创和固定。27例（84%）患者进行了肌肉转移。初次清创至肌肉转移的时间为3至24天（平均4天）。在软组织覆盖后6周至8个月（平均8周）进行骨移植。患者接受静脉抗生素治疗2至6周（平均6周）。20例患者接受前路植骨，10例接受后外侧植骨，2例两者均接受。随访时间为12至49个月（平均28个月）。32例患者中有29例（91%）在骨移植后3至10个月（平均5.5个月）实现胫骨愈合。3例失败的胫骨在后外侧植骨后愈合。32例患者的感染均得到控制。采用感染控制原则的自体松质骨移植是治疗感染性胫骨骨不连的有效方法。
