Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases.
Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases.
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DOI：
10.1186/s12891-020-03734-z
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发表时间：
2020-10-28
影响因子：
2.3
通讯作者：
Qin CH
中科院分区：
文献类型：
--
作者：
Zhang HA;Zhou CH;Meng XQ;Fang J;Qin CH
髓内感染的发生率随着髓内固定在长骨骨折中应用的增加而增加。然而，髓内钉术后感染的适当治疗尚不清楚。本研究的目的是报告我们的髓内钉术后感染治疗方案的结果：髓内钉取出，局部清创，扩髓和冲洗，以及骨水泥负载硫酸钙植入，伴或不伴节段性骨切除和牵引成骨。我们回顾性分析了2014年至2017年在我中心接受髓内钉治疗后发生感染的患者记录。随访时间少于24个月、接受其他治疗方法或患有严重疾病的患者被排除在分析之外。符合标准的患者按上述方法治疗，9例行牵张成骨术修复骨缺损。评估感染缓解率、感染复发率和术后并发症发生率。共有19例患者纳入分析。随访24 ~ 55个月，平均38.1 ± 9.4个月。18例患者（94.7%）达到感染缓解; 1例患者（5.3%）发生再感染，在重复清创后消退。9例骨缺损患者（平均4.7 ± 1.3 cm，范围3.3 ~ 7.6 cm）采用骨转移治疗，成功恢复了受累肢体的长度。平均骨转运时间为10.7 ± 4.0个月（范围：6.7 - 19.5个月）。大多数患者在随访期间实现了完全负重，并且疼痛消失。术后并发症主要包括长时间无菌引流（7/19; 36.8%）、再骨折（1/19; 5.3%）和关节僵硬，分别通过定期换药和重新固定成功处理。髓内钉取出、髓腔扩髓和冲洗以及骨水泥负载硫酸钙植入（伴或不伴牵张成骨）对治疗髓内钉术后感染有效。
The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.
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DOI：
10.1302/0301-620x.80b5.8513
发表时间：
1998-09-01
影响因子：
--
作者：
Granchi, D;Verri, E;Montanaro, L
通讯作者：
Montanaro, L
影响因子：
2.3
作者：
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Mckee, Michael D.
影响因子：
2.3
作者：
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通讯作者：
Court-Brown, CM
DOI：
10.2174/1874325001307010219
发表时间：
2013-01-01
期刊：
The open orthopaedics journal
影响因子：
--
作者：
Makridis, Kostas G;Tosounidis, Theodoros;Giannoudis, Peter V
通讯作者：
Giannoudis, Peter V
DOI：
10.1016/j.injury.2017.08.040
发表时间：
2018-03-01
影响因子：
2.5
作者：
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Verhofstad, M. H. J.