Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes.
Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes.
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DOI：
10.2174/1874325001307010219
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发表时间：
2013-01-01
期刊：
影响因子：
--
通讯作者：
Giannoudis, Peter V
中科院分区：
文献类型：
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作者：
Makridis, Kostas G;Tosounidis, Theodoros;Giannoudis, Peter V
植入物相关败血症是长骨骨折髓内钉固定的一种相对罕见的并发症。根据感染的程度、诊断的时间和骨折愈合的进展，已经开发了不同的治疗策略。这篇综述文章的目的是收集和分析关于长骨骨折髓内钉固定术后感染发生率和管理的现有证据，并推荐在日常临床实践中可能有价值的治疗方案。检索P u B M e d /Medline数据库，共检索到近20年来与该主题相关的文献1270篇。最终审查纳入了28篇符合纳入标准的文章。只有少数前瞻性研究报告了长骨骨折髓内钉固定后的感染管理。一般而言，I期（早期）感染仅需要抗生素给药，伴/不伴清创。II期（迟发性）感染可通过清创术、IM扩髓、抗生素髓内钉和抗生素给药成功治疗。感染性骨不连的最佳治疗方法是更换髓内钉，抗生素治疗，如果需要，当感染已被根除时植入移植物。清创、更换髓内钉和全身抗生素治疗是III期（晚期）感染的最佳适应症，而III期感染性骨不连可通过髓内钉取出和Ilizarov支架成功治疗，尤其是存在大面积骨缺损时。
Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.