| 曾文容,陈卫,陈志达,等.胫骨平台骨折术后感染性骨缺损的分型和治疗策略.骨科,2021,12(3): 211-219. |
| 胫骨平台骨折术后感染性骨缺损的分型和治疗策略 |
| Classification and management of infective bone defects of tibial plateau. |
| 投稿时间：2021-03-15 |
| DOI：10.3969/j.issn.1674-8573.2021.03.005 |
| 中文关键词: 胫骨平台 感染 骨缺损 分型 治疗 |
| 英文关键词: Tibial plateau Infection Bone defect Classification Treatment |
| 基金项目:漳州市自然科学基金（ZZ2018J10） |
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| 中文摘要: |
| 目的 探讨胫骨平台骨折术后不同程度感染性骨缺损治疗策略的选择。方法 回顾性分析2014年7月至2018年2月我院收治的45例胫骨平台骨折术后感染性骨缺损病人的临床资料，其中男32例，女13例，年龄为（39.42±12.09）岁（20~66岁）。腔洞性骨缺损16例，节段性骨缺损16例，波及关节面的缺损13例。Ⅰ型为胫骨平台内腔洞性骨缺损；Ⅱa型为胫骨平台下节段性（＜4 cm）并平台内腔洞性骨缺损；Ⅱb型胫骨平台下节段性（≥4 cm）并平台内腔洞性骨缺损；Ⅲa型胫骨平台波及关节面的缺损，但节段性缺损＜4 cm；Ⅲb型为胫骨平台波及关节面的缺损，但节段性缺损≥4 cm。所有病人一期彻底扩创取出内固定，二期按照胫骨平台骨缺损情况进行分型治疗。记录病人一期手术前、二期手术后3个月的炎性指标（白细胞计数、C-反应蛋白、红细胞沉降率和降钙素原）、膝关节活动度、美国特种外科医院（Hospital for Special Surgery，HSS）膝关节评分，及术后并发症、骨折愈合情况。结果 病人随访时间为（25.25±3.32）个月（17~56个月），骨折愈合时间为（11.21±4.43）个月（8~17个月），伤口愈合较满意，其中8例行腓肠肌肌瓣转移术覆盖伤口，10例行同侧大腿取皮局部植皮术，1例节段性骨缺损术后10个月骨折未见明显愈合，再次手术植骨后6个月得到愈合。随访2年未见伤口破溃及感染复发。在观察期间未见固定失败、再骨折、神经损伤、下肢深静脉血栓、肺栓塞等并发症的发生。二期术后3个月各炎性指标、膝关节活动度、HSS评分与一期术前比较，差异均有统计学意义（P均＜0.05）。末次随访时，病人患膝HSS评分为（89.23±5.35）分（82~94分）。结论 根据胫骨平台术后感染性骨缺损进行分型治疗，临床疗效良好，为胫骨平台术后感染性骨缺损诊疗提供了策略。 |
| 英文摘要: |
| Objective To explore the treatment strategy of infectious bone defects in different degrees after tibial plateau operation. Methods From July 2014 to February 2018, 45 patients with infected bone defects in postoperative tibial plateau fractures were retrospective analyzed, including 32 males and 13 females with age of (39.42±12.09) years (range 20-66 years). There were 16 cases of lacunar bone defect, 16 cases of segmental bone defect and 13 cases of defect affecting the articular surface. Type Ⅰ was lacunar bone defect of the tibial plateau, type Ⅱa was a segmental bone defect of the tibial plateau (＜4 cm) with lacunar bone defect, type Ⅱb was segmental bone defect of the tibial plateau (≥4 cm) with lacunar bone defect, type Ⅲa was tibial plateau affecting the articular surface defect, but the segmental defect was less than 4 cm, and type Ⅲb was tibial plateau affecting the articular surface defect, but the segmental defect was ≥ 4 cm. All patients obtained the first-stage wound expansion and internal fixation was taken out. And the tibial plateau bone defect was classified and treated in the second stage. The white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin and other inflammatory indexes before the first-stage operation and 3 months after the second-stage operation, as well as range of motion of knee joint, American Hospital for Special Surgery (HSS) score and complications symptoms and fracture healing were recorded and compared. Results All patients were followed up for (25.25±3.32) months (17-56 months). The fracture healing time was (11.21±4.43) months (8-17 months). The wounds of the patients healed satisfactorily. Among them, 8 cases underwent gastrocnemius muscle flap transfer to cover the wound, 10 cases underwent local skin grafting of the ipsilateral thigh, 1 case of segmental bone defect showed no obvious healing of the fracture after 10 months. The bone defect healed 6 months after bone graft. There was no wound rupture or recurrence of infection during the follow-up of 2 years. During the observation period, there were no complications such as failure of fixation, re-fracture, nerve injury, deep vein thrombosis of lower limbs, and pulmonary embolism. Three months after the second stage, WBC count, CRP, ESR, procalcitonin, motion of knee joint and HSS scores showed significant difference from those preoperation (all P＜0.05). At the final follow-up, the HSS score of the affected knee was (89.23±5.35) (82-94). Conclusion Management of infected bone defect of tibial plateau according to our classification can obtain satisfactory curative effect, and provide treatment strategies for infectious bone defect of tibial plateau. |
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