抗生素骨水泥间隔剂联合诱导膜骨移植治疗股骨远端开放性骨折骨质丢失影像学和功能预后:一项回顾性研究

IF 0.2 Q4 EMERGENCY MEDICINE
D. Patel, Avtar Singh, Rajeev Vohra, S. Chauhan, Babaji Thorat
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引用次数: 2

摘要

背景:开放性骨折是一个困难的实体,经常并发感染和不愈合。这种骨折的骨质流失增加了复杂性。传统的骨缺损治疗技术主要针对骨折愈合,而不是针对预防感染或关节僵硬。目的:在本研究中,我们评估Masquelet技术治疗开放性股骨远端骨折伴骨丢失。方法:选取2015年1月至2018年12月22例创伤后3天内出现开放性远端骨折伴骨缺损的患者,采用Masquelet技术治疗。所有的病人都由同一个外科医生做手术。所有患者在报告后立即接受第一阶段手术。详细记录了损伤类型、位置、软组织状况、骨缺损长度、固定类型、抗生素骨水泥垫片放置与植骨的时间差异以及愈合时间。结果:IV型骨丢失(节段性丢失)骨折愈合速度慢于具有一定皮质连续性的骨折(II型和III型),P=0.003。IV型患者骨丢失至愈合的平均时间为316.6±44.5天,而III型和II型患者分别为240±30和180天。在第一阶段,所有病例均采用抗生素骨水泥垫片内固定。内固定二期取出间隔物+植骨组患者愈合时间为244.1±42.9天。第一阶段手术后没有患者发生感染。结论:骨水泥垫片初始放置后延迟植骨技术为四肢重建中严重骨丢失的难题提供了一种合理的选择。该技术可用于急性或延迟的方式,同样有希望的结果。用骨水泥填充大骨缺损所产生的膜的生物活性为骨形成和大空隙的骨巩固提供了有利的环境。随着这项技术得到更广泛的应用,在真空中放置哪种移植物的答案可能会变得更加清晰。越来越多的临床证据也将有助于支持使用该技术治疗节段性骨丢失。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Distal End Femur Fractures with Bone Loss; Radiographic and Functional Outcomes: A Retrospective Study
Background: Open fractures are a difficult entity, often complicated by infection and nonunion. Bone loss in such fractures adds to the complexity. Conventional techniques of bone defect management are mainly directed toward fracture union but not against preventing infection or joint stiffness.Objectives: In this study, we evaluated Masquelet's technique for the management of open distal end Femur fractures with bone loss.Methods: Twenty-two patients with open distal end fractures with bone defects who presented within 3 days of trauma from January 2015 to December 2018, treated by the Masquelet's technique are included in this study. All the patients were operated on by the same surgeon. All the patients were taken up for the first stage of surgery immediately after the presentation. Details of the type of injury, location, soft-tissue condition, length of bone defect, type of fixation, the time difference between antibiotic cement spacer placement and bone grafting, and time to the union were documented.Results: Fractures with Type IV bone loss (segmental loss) united slower than fractures having some cortical continuity (Type II and III), P=0.003. In Type IV, the bone loss average time to union was 316.6±44.5 days, whereas, in Type III and II, it was 240±30 and 180, respectively. In the first stage, internal fixation with antibiotics cement spacer was done in all cases. In patients with internal fixation with 2nd stage spacer removal plus bone grafting done, time to union was 244.1±42.9 days. No patients had an infection after the first stage of surgery.Conclusion: The technique of delayed bone grafting after the initial placement of a cement spacer provides a reasonable alternative for the challenging problem of significant bone loss in extremity reconstruction. This technique can be used in either an acute or delayed fashion with equally promising results. The bioactivity of the membrane created by filling large bony defects with cement leads to a favorable environment for bone formation and osseous consolidation of a large void. As this technique becomes more widely applied, the answer to which graft substances to place in the void may become clearer. Increasing clinical evidence will also help support the use of this technique in treating segmental bone loss.
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Trauma monthly
Trauma monthly EMERGENCY MEDICINE-
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