感染性胫骨骨不连的治疗:合成骨移植与持续局部抗生素灌注(CLAP)相结合。

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Kenichi Sawauchi, Tomoaki Fukui, Keisuke Oe, Ryosuke Kuroda, Takahiro Niikura, Hirotsugu Muratsu, Akihiro Maruo
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引用次数: 0

摘要

背景 控制感染和重建骨与软组织是治疗感染性骨不连的关键。持续局部抗生素灌注(CLAP)是一种给药系统,可按要求的浓度、面积和持续时间持续输送抗生素。本病例报告描述了一个感染性骨不连的病例,通过 CLAP 和人工合成骨移植,在保留植入物的同时根除了感染并实现了骨结合。病例报告 该病例是一名感染性骨不连的 31 岁女性。她因胫骨和腓骨的开放性骨折接受了钉式骨合成术,但仍未实现骨结合,并出现皮肤缺损和脓液引流。清除骨缺损处受感染的肉芽组织后,将两根骨髓针作为髓内抗生素灌注(iMAP)针插入胫骨髓腔。在皮下袋中放置了一根双腔管,作为软组织内抗生素灌注(iSAP)管。在骨缺损和钉子周围未观察到骨移动,因此无需更换植入物。在骨缺损处移植了β-磷酸三钙,并进行了伤口负压治疗。通过 iMAP 和 iSAP 持续注射庆大霉素。最后,感染被根除,并观察到皮质骨桥的形成,没有进行额外的手术,也没有出现不良反应。结论 CLAP 是治疗感染性骨不连的一种可行方法,因为它能以足以控制感染的浓度注射抗生素,同时还能让外科医生灵活设计注射抗生素的区域、剂量和持续时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of Infected Tibial Nonunion: Combining Synthetic Bone Grafting with Continuous Local Antibiotic Perfusion (CLAP).

BACKGROUND Infection control and reconstruction of bone and soft tissue are essential for treating infected nonunion. Continuous local antibiotic perfusion (CLAP) is a drug delivery system that continuously delivers antibiotics at the required concentration, area, and duration. This case report describes the instance of infected nonunion in which infection eradication and bone union were achieved using CLAP and synthetic bone grafting while retaining the implant. CASE REPORT The case was a 31-year-old woman with an infected nonunion. After she underwent osteosynthesis using nail for open fractures of tibia and fibula, bone union remained unachieved, and she exhibited skin defects and draining of pus. Following the removal of the infected granulation tissue from the bone defects, 2 bone marrow needles, serving as intramedullary antibiotic perfusion (iMAP) pins, were inserted into the medullary cavity tibia. A double-lumen tube was placed in the subcutaneous pocket as the intra-soft tissue antibiotic perfusion (iSAP) tube. No bone mobility was observed around the bone defect and nail, and replacement of the implant was not necessary. Beta-tricalcium phosphate was transplanted to the bone defect, and negative pressure wound therapy was applied. Gentamicin was injected continuously through iMAP and iSAP. Finally, the infection was eradicated, and cortical bone bridging was observed without additional surgery or adverse effects. CONCLUSIONS CLAP emerges as a viable treatment option for infected nonunion, as it enables the delivery of antibiotics at a concentration sufficient for infection control while providing the surgeon with flexibility to design the area, dosage, and duration of antibiotic delivery.

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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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