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ENGLISH ABSTRACT
膜诱导技术治疗成人股骨转子间骨折内固定术后慢性骨感染的疗效分析
谢云飞
鲁笑天
苏一桐
罗想利
厉孟
作者及单位信息
·
DOI： 10.3760/cma.j.cn115530-20241111-00438
Membrane induction technique to treat chronic bone infection after internal fixation of intertrochanteric fracture in adults
Xie Yunfei
Lu Xiaotian
Su Yitong
Luo Xiangli
Li Meng
Authors Info & Affiliations
Xie Yunfei
The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730099, China
Lu Xiaotian
The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730099, China
Su Yitong
The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730099, China
Luo Xiangli
Department of Traumatic Orthopaedics Ⅱ, Gansu Provincial People's Hospital, Lanzhou 730099, China
Li Meng
Department of Traumatic Orthopaedics Ⅱ, Gansu Provincial People's Hospital, Lanzhou 730099, China
·
DOI： 10.3760/cma.j.cn115530-20241111-00438
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摘要

目的探讨膜诱导技术治疗成人股骨转子间骨折内固定术后慢性骨感染的疗效。

方法回顾性分析2019年5月至2022年5月期间甘肃省人民医院创伤骨科二病区收治并获完整随访的15例成人股骨转子间骨折内固定术后慢性骨感染患者资料。男13例，女2例；年龄（55.8±2.6）岁。Cierny-Mader解剖分型：Ⅲ型6例，Ⅳ型9例；宿主分型：A型10例，B型5例。骨感染病程为（22.1±8.1）个月。所有患者均采用膜诱导技术分2期治疗：一期病灶清创后骨缺损长度为（4.50±0.54）cm，在缺损区置入抗生素骨水泥，临时固定骨折断端；6~8周感染控制后行二期骨缺损修复重建手术。记录患者的感染控制情况、并发症发生情况、骨性愈合时间，以及末次随访时Samantha X线骨愈合评分、站立疼痛视觉模拟评分（VAS）、髋关节功能等。

结果15例患者术后获（27.5±2.5）个月随访。2例患者一期术后出现感染复发，予再次清创后得到有效控制，随访期间再无复发。15例患者随访期间均未发生取骨区感染、重建骨变形塌陷、肢体短缩、再骨折及内固定失效等并发症。15例患者术后均获骨性愈合，愈合时间为（10.3±2.1）个月。末次随访时15例患者的Samantha X线骨愈合评分为6.0(5.0,6.0)分，站立疼痛VAS评分为1.0(1.0,3.0)分。末次随访时根据Sanders髋关节创伤后评分标准评定髋关节功能：优10例，良5例；根据Paley感染性骨缺损愈合评分标准评定疗效：优7例，良2例，可6例。

结论膜诱导技术治疗成人股骨转子间骨折内固定术后慢性骨感染，可有效控制感染，改善患者髋关节功能，疗效良好。

髋骨折;骨疾病，感染性;骨折固定术，内;膜诱导技术
ABSTRACT

ObjectiveTo explore the clinical efficacy of membrane induction technique in the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults.

MethodsThe data were retrospectively analyzed of the 15 adult patients who had been treated for chronic bone infection after internal fixation of intertrochanteric fracture at Department of Traumatic Orthopaedics Ⅱ, Gansu Provincial People's Hospital from May 2019 to May 2022. There were 13 males and 2 females with an age of (55.8±2.6) years. By the Cierny-Mader anatomical classification, 6 cases were type Ⅲ and 9 cases type Ⅳ; by the physiological classification, 10 cases were type A and 5 cases type B. Course of bone infection was (22.1±8.1) months. All patients were treated by membrane induction technique in 2 stages. In the first stage, antibiotic bone cement was implanted after debridement into the defects [(4.50±0.54) cm in length] followed by temporary fixation of broken ends of the fracture. After 6 to 8 weeks when infection was controlled, the second stage repair and reconstruction of bone defects was carried out. Infection control, complications, bone healing time, and Samantha X-ray bone healing score, visual analogue scale (VAS) at standing, Sanders hip score and Paley score for bone defect healing at the last follow-up were recorded.

ResultsThe 15 patients were followed up for (27.5±2.5) months. Infection recurred after the first-stage operation in 2 cases, but was effectively controlled after debridement and follow-up observed no recurrence. Follow-up showed no such complications as donor site infection, deformation or collapse of the bone reconstructed, limb shortening, re-fracture or internal fixation failure in the 15 patients who achieved bony union after (10.3±2.1) months. At the last follow-up, the Samantha X-ray score was 6.0(5.0, 6.0) points and VAS at standing 1.0(1.0, 3.0) point for the 15 patients; by Sanders hip score, the hip function was rated as excellent in 10 cases and as fine in 5 cases; by Paley score for bone defect healing, the efficacy was rated as excellent in 7 cases, as good in 2 cases and as fair in 6 cases.

ConclusionIn the treatment of chronic bone infection after internal fixation of intertrochanteric fracture in adults, membrane induction technique can effectively control infection and improve the hip function of the affected limb, leading to good clinical efficacy.

Hip fractures;Bone diseases, infectious;Fracture fixation, internal;Membrane induction technique
Li Meng, Email: mocdef.3ab61ilnoilil
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引用本文

谢云飞,鲁笑天,苏一桐,等. 膜诱导技术治疗成人股骨转子间骨折内固定术后慢性骨感染的疗效分析[J]. 中华创伤骨科杂志,2025,27(03)：197-203.

DOI:10.3760/cma.j.cn115530-20241111-00438

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近年来，随着骨折内固定技术的不断改进，内固定数量也相应增加，伴随而来的是内固定术后骨感染发生率的攀升 [ 1 ]。文献报道股骨转子间骨折髓内钉固定术后骨感染的发生率为0~3.6% [ 2 ]，发生骨感染患者术后90 d、1年病死率分别高达42%、55%，而未发生骨感染患者则分别为14%、24% [ 3 ]，且额外增加医疗支出 [ 4 ]。内固定术后慢性骨感染的治疗极具挑战性，涉及骨感染和骨不愈合两大难题。大多数学者建议首先全面彻底清除感染组织，待感染控制后进一步再行骨重建 [ 5 ]。由于股骨转子间特殊的解剖及生物力学决定了骨重建的复杂性，彻底清创后骨质的大量丢失会导致固定不稳定，容易造成骨折不愈合或畸形愈合，此时骨重建的方式显得尤为重要。传统的自体骨移植、带血管蒂游离组织移植、Ilizarov技术存在治疗时间长、技术要求高、并发症多及患者耐受性差等缺点 [ 6 ]。自Masquelet等 [ 7 ]应用膜诱导技术成功治愈长达25 cm的大段骨缺损后，该技术广泛应用于肿瘤、先天性疾病和非感染性因素等导致的骨缺损的治疗 [ 8 ]。膜诱导技术不仅具有骨缺损组织愈合快、操作简单及治疗周期短等优点，而且符合治疗骨缺损的钻石理念，即强调在骨愈合过程中重视生长因子、成骨诱导支架及成骨细胞的同时，还应积极恢复骨折断端的生物力学稳定 [ 9 ]。近年来，越来越多的学者将膜诱导技术应用于股骨干及胫骨骨感染的治疗 [ 10 , 11 ]，但对于邻近关节的股骨转子间骨折内固定术后慢性骨感染的治疗鲜有文献报道。本研究回顾性分析2019年5月至2022年5月期间甘肃省人民医院创伤骨科二病区收治的15例成年股骨转子间骨折内固定术后慢性骨感染患者资料，探讨膜诱导技术治疗成人股骨转子间骨折内固定术后慢性骨感染的效果。
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备注信息
A
厉孟，Email: mocdef.3ab61ilnoilil
B

谢云飞：资料收集、文章撰写；鲁笑天、苏一桐：资料收集、数据及图片整理；罗想利：手术操作；厉孟：研究设计、内容构思、观点形成、手术操作、文章修改并对文章的知识性内容作批评性审阅

C
所有作者声明无利益冲突
D
甘肃省自然科学基金 (24JRRA1046)
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