Two-Stage Reosteosynthesis of Tibia in the Patient with Fracture Non-Union Complicated by Postoperative Osteomyelitis
Two-Stage Reosteosynthesis of Tibia in the Patient with Fracture Non-Union Complicated by Postoperative Osteomyelitis
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DOI：
10.21823/2311-2905-2018-24-1-108-114
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发表时间：
2018-01-01
影响因子：
0.3
通讯作者：
Shevalaev, G. A.
中科院分区：
文献类型：
--
作者：
Efremov, I. M.;Sibaev, F. Ya.;Shevalaev, G. A.
作者提出了一个病例报告的病人与假关节的右胫骨并发慢性术后骨髓炎。骨髓炎过程的发展是由逆行髓内钉锁定右胫骨引起的。术后发生急性感染和骨髓炎，对慢性感染病灶进行彻底清创，取出锁定螺钉和髓内钉，用专用扩髓器处理胫骨髓腔，清除坏死骨组织。作者使用脉冲灌洗并主动清除溶液，对手术伤口和髓腔进行额外灭菌。在髓腔中放置一个浸渍有万古霉素和多价噬菌体的加强间隔器，以确保局部长期抗菌治疗。代替去除的单体，将多价噬菌体引入到聚合物组合物中，包括抗创伤学和整形外科临床患者中主要感染因子的抗菌剂。手术的第二阶段包括取出垫片，通过带有抗菌涂层的骨水泥（浸渍万古霉素和多价噬菌体）的髓内钉闭合顺行锁定内固定右侧胫骨和距骨。术中使用原始模具制作髓内钉的抗菌涂层。两阶段手术可以实现慢性骨髓炎的稳定缓解和胫骨假关节的稳定内固定，并保留下肢的支撑功能。
The authors present a case report of a patient with pseudarthrosis of the right tibia complicated by chronic postoperative osteomyelitis. The development of the osteomyelitis process is caused by locked intramedullary fixation of the right tibia by a retrograde nail. Unstable fixation led to the development of acute periimplant infection and osteomyelitis.A radical surgical debridement of the focus site of chronic infection was performed by removing locking screws and nail, removal of necrotic bone tissues by handling the tibial medullary cavity by special reamers. The authors used the pulse lavage with active removal of the solution for an additional sterilization of the surgical wound and medullary cavity. A reinforced spacer impregnated with vancomycin and polyvalent bacteriophage was placed in the medullary cavity to ensure local prolonged antimicrobial therapy. Instead of the removed monomer the polyvalent bacteriophage was introduced into the polymer composition including phages against the main infectious agents in patients of traumatology and orthopedics clinic.Three months after the first stage of treatment and stabilization of laboratory parameters the patient was readmitted to the clinic. The second stage of procedure included removal of spacer, closed antegrade locked internal fixation of the right tibia and talus by a nail with an antimicrobial coating of bone cement impregnated with vancomycin and a polyvalent bacteriophage. Antimicrobial coating of the nail was made intraoperatively using an original mold.Two stage procedure allowed to achieve a stable remission of chronic osteomyelitis and stable internal fixation of tibia pseudarthrosis with preservation of the supporting function of the lower limb.