Staged Protocol for the Treatment of Chronic Tibial Shaft Osteomyelitis With Ilizarov's Technique Followed by the Application of Intramedullary Locked Nail
Staged Protocol for the Treatment of Chronic Tibial Shaft Osteomyelitis With Ilizarov's Technique Followed by the Application of Intramedullary Locked Nail
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DOI：
10.3928/01477447-20121120-23
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发表时间：
2012-12-01
期刊：
影响因子：
1.1
通讯作者：
Chen, Tain-Hsiung
中科院分区：
文献类型：
--
作者：
Lin, Chun-Cheng;Chen, Chuan-Mu;Chen, Tain-Hsiung
开放性胫骨干骨折是最常见的开放性骨折，可能会发生许多并发症。治疗期间，感染导致骨髓炎是最常见的并发症。然而，文献中对于此类病例的理想治疗方法尚未达成共识。这项回顾性研究的目的是回顾过去 14 年转诊至作者所在机构的慢性胫骨干骨髓炎患者的治疗情况，并提供伤口自发愈合的分阶段方案。分阶段方案包括：（1）对感染的骨和软组织进行彻底清创； (2) 除需要延迟使用的患者外，所有患者立即使用伊利扎罗夫装置； (3)健康骨骼截骨术； (4)同时牵张压缩成骨和组织生成； (5)附加对接部位植骨； (6) 当在牵引部位可见骨痂形成时，将外固定器移至锁钉上。 16例患者中有15例获得愈合，平均外固定时间4.5个月（范围3-6个月）。没有发生畸形或腿长差异大于1厘米。在慢性骨髓炎的治疗中，这种分阶段方案是安全且成功的，并且允许愈合、重新对齐、重新定向和腿长恢复。对于软组织，该技术为感染伤口提供了一种独特的重建闭合方式。建议分阶段方案在没有皮瓣覆盖的情况下成功地同时重建骨和软组织缺陷是可靠的。
Open tibial shaft fractures are the most common open fractures, and many complications can occur. During the treatment period, infection leading to osteomyelitis was the most common complication. However, no consensus exists regarding the ideal management for such cases in the literature.The purposes of this retrospective study were to review the treatment of patients with chronic tibial shaft osteomyelitis over the past 14 years who were referred to the authors' institution and to provide a staged protocol for spontaneous wound healing. The staged protocol included: (1) radical debridement for infected bone and soft tissue; (2) immediate application of Ilizarov's apparatus for all patients except those needing delayed application; (3) osteotomy in healthy bone; (4) simultaneous distraction-compression osteogenesis and histogenesis; (5) additional docking-site bone grafting; and (6) shifting the external fixator to a locked nail when callus formation was visible at the distraction site. Union was achieved in 15 of 16 patients, with an average external fixation time of 4.5 months (range, 3-6 months). No deformity or leg-length discrepancy greater than 1 cm occurred.In the treatment of chronic osteomyelitis, this staged protocol was safe and successful and allowed for union, realignment, reorientation, and leg-length restoration. Regarding the soft tissues, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.