林鹏;蔡锦芳;李宗玉;解琛;王建超;

• 1:第二军医大学教学医院济南军区总医院全军创伤骨科研究所
• 2:解放军第401医院骨科

摘要(Abstract)：

[目的]比较一期与二期植骨治疗肢体骨折术后继发Ceirny-Mader Ⅲ~Ⅳ型骨髓炎的临床疗效。[方法]回顾分析采用改良Papineau技术一期植骨(一期组)和万古霉素载荷PMMA骨水泥置入后二期植骨(二期组)治疗肢体骨折术后并发Ceirny-Mader Ⅲ~Ⅳ型骨髓炎病例共59例。一期组27例,采用改良Papineau技术,即一期开放自体髂骨植骨结合封闭负压技术(VAC)。二期组32例,采用一期万古霉素载荷PMMA局部应用,术后12周,取出PMMA珠链或团块,二期取自体髂骨植骨。比较两组骨髓炎创口愈合时间、骨愈合时间、感染复发率及术后恢复情况。[结果]纳入研究的59例中,成功治愈并随访2年以上的病例49例。一期组手术1次,术后创面愈合时间为14~25(17.91±3.92)d,骨愈合时间为4~8(5.52±1.33)个月;二期组手术2次,两阶段围手术期创口愈合时间为24~32(27.01±2.38)d,骨愈合时间为5~9(6.64±1.13)个月。一期组围手术期创面总愈合时间及骨愈合时间优于二期组,差异有统计学意义(P<0.001)。一期组中6例,二期组中4例术后局部感染复发,改行其他治疗,两组间感染复发率差异无统计意义(P=0.488)。末次复诊SF36总评分一期组为(102.38±7.01)分,二期组为(102.69±3.67)分,两组间差异无统计意义(P=0.841)。[结论]改良Papineau技术一期植骨与常规二期植骨治疗开放骨折术后并发Ceirny-Mader Ⅲ~Ⅳ型骨髓炎疗效和复发率相当,在骨折愈合时间、手术次数以及围手术其创面或创口总愈合时间上一期植骨更具优势。

关键词(KeyWords)： 自体植骨术;抗生素骨水泥;骨髓炎

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 林鹏;蔡锦芳;李宗玉;解琛;王建超;

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参考文献(References)：

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