84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]劉兵,馬翔宇,楊超,等.替加環(huán)素骨水泥涂層髓內(nèi)釘固定結(jié)合膜誘導(dǎo)技術(shù)治療革蘭氏陰性桿菌所致脛骨干感染性骨缺損[J].中醫(yī)正骨,2020,32(09):66-69.
點(diǎn)擊復(fù)制

替加環(huán)素骨水泥涂層髓內(nèi)釘固定結(jié)合膜誘導(dǎo)技術(shù)治療革蘭氏陰性桿菌所致脛骨干感染性骨缺損()
分享到:

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年09期
頁碼:
66-69
欄目:
臨床報(bào)道
出版日期:
2020-09-20

文章信息/Info

作者:
劉兵馬翔宇楊超解冰周大鵬
(中國人民解放軍北部戰(zhàn)區(qū)總醫(yī)院,遼寧 沈陽 110016)
關(guān)鍵詞:
脛骨骨折 感染 骨缺損 膜誘導(dǎo)技術(shù) 抗菌藥 替加環(huán)素 骨水泥 革蘭氏陰性桿菌
摘要:
目的:探討替加環(huán)素骨水泥涂層髓內(nèi)釘固定結(jié)合膜誘導(dǎo)技術(shù)治療革蘭氏陰性桿菌所致脛骨干感染性骨缺損的臨床療效與安全性。方法:2017年2月至2019年2月收治14例革蘭氏陰性桿菌所致脛骨干感染性骨缺損患者。男8例,女6例。年齡27~69歲,中位數(shù)45.5歲。原始脛骨損傷包括開放性骨折9例、閉合性骨折5例。初次骨折固定方式包括髓內(nèi)釘固定6例、接骨板固定5例、外固定架固定3例。骨折至本次手術(shù)時(shí)間4~15個(gè)月,中位數(shù)10個(gè)月。均伴有竇道形成、皮膚軟組織缺損或骨外露。均不合并精神疾病、代謝性骨病、嚴(yán)重營養(yǎng)不良以及其他部位骨折。竇道分泌物細(xì)菌培養(yǎng)結(jié)果,大腸埃希菌4例、銅綠假單胞菌3例、陰溝腸桿菌3例、鮑曼不動(dòng)桿菌2例、肺炎克雷伯菌2例。采用替加環(huán)素骨水泥涂層髓內(nèi)釘固定結(jié)合膜誘導(dǎo)技術(shù)治療,第1階段手術(shù)行清創(chuàng)、替加環(huán)素骨水泥涂層髓內(nèi)釘固定及骨缺損部位抗生素骨水泥填充,第2階段手術(shù)取出骨水泥并以自體髂骨松質(zhì)骨、皮質(zhì)骨混合骨水泥移植。隨訪觀察感染控制、骨愈合及并發(fā)癥發(fā)生情況,采用Johner-Wruhs脛骨干骨折療效評(píng)價(jià)標(biāo)準(zhǔn)評(píng)價(jià)臨床療效。結(jié)果:清創(chuàng)后脛骨干骨缺損長(zhǎng)度(5.2±1.2)cm,細(xì)菌培養(yǎng)結(jié)果均為陰性。第1階段手術(shù)后,感染均得到控制。所有患者均獲得隨訪,隨訪時(shí)間12~24個(gè)月,中位數(shù)18個(gè)月。骨缺損均骨性愈合,愈合時(shí)間4.5~9個(gè)月,中位數(shù)5.5個(gè)月。末次隨訪時(shí),根據(jù)Johner-Wruhs脛骨干骨折療效評(píng)價(jià)標(biāo)準(zhǔn),優(yōu)8例、良4例、中2例。2例患者第1階段手術(shù)后出現(xiàn)切口皮緣組織部分壞死,經(jīng)換藥處理后切口均順利愈合。3例患者出現(xiàn)踝關(guān)節(jié)前方長(zhǎng)伸肌螺釘激惹癥狀,取出內(nèi)固定后癥狀均消失; 均無感染復(fù)發(fā)、內(nèi)固定失效等并發(fā)癥發(fā)生。結(jié)論:替加環(huán)素骨水泥涂層髓內(nèi)釘固定結(jié)合膜誘導(dǎo)技術(shù)治療革蘭氏陰性桿菌所致脛骨干感染性骨缺損,能有效控制感染,有利于骨折愈合和患肢功能恢復(fù),且安全性高。

參考文獻(xiàn)/References:

[1] KANAKARIS N,GUDIPATI S,TOSOUNIDIS T,et al.The treatment of intramedullary osteomyelitis of the femur and tibia using the reamer-irrigator-aspirator system and antibiotic cement rods[J].Bone Joint J,2014,96-B(6):783-788.
[2] 李樹源,周琦石,陳超,等.誘導(dǎo)膜技術(shù)與骨搬運(yùn)技術(shù)治療脛骨創(chuàng)傷性骨髓炎的療效比較[J].中國中醫(yī)骨傷科雜志,2019,27(1):17-21.
[3] 范磊,韓興超,李曉彬,等.骨科創(chuàng)面感染病原學(xué)特征分析[J].中國病原生物學(xué)雜志,2018,13(6):641-643.
[4] WANG J B,YIN Q D,GU S J,et al.Induced membrane technique in the treatment of infectious bone defect:a clinical analysis[J].OrthopTraumatol Surg Res,2019,105(3):535-539.
[5] QIU X S,CHENG B,CHEN Y X,et al.Coating the plate with antibiotic cement to treat early infection after fracture fixation with retention of the implants:a technical note[J].BMC Musculoskelet Disord,2018,19(1):360.
[6] DE MEO D,CALOGERO V,ARE L,et al.Antibiotic-loaded hydrogel coating to reduce early postsurgical infections in aseptic hip revision surgery:a retrospective,matched case-control study[J].Microorganisms,2020,8(4):571.
[7] SKOVDAL S M,J?RGENSEN N P,PETERSEN E,et al.Ultra-dense polymer brush coating reduces Staphylococcus epidermidis biofilms on medical implants and improves antibiotic treatment outcome[J].Acta Biomater,2018,76:46-55.
[8] 劉志雄.骨科常用診斷分類方法和功能結(jié)果評(píng)定標(biāo)準(zhǔn)[M].北京:北京科學(xué)技術(shù)出版社,2005:296-297.
[9] KOUTSERIMPAS C,SAMONIS G,PLATAKI M N,et al.Multidrug-resistant Gram-negative osteomyelitis:a 10-year study[J].G Chir,2018,34(5):284-290.
[10] CLINICAL AND LABORATORY STANDARDS INSTITUTE.Performance standards for antimicrobial susceptibility testing standards:twentyfourth informational supplement:M100-S24[S].Wayne:Clinical And Laboratory Standards Institute,2014:203-204.
[11] ALTUN S,KOCAK T Z,ALTUN B,et al.Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy[J].Turk J Med Sci,2016,46(6):1894-1899.
[12] NICHOL T,SMITH T J,TOWNSEND R,et al.Analysis of linezolid and tigecycline as candidates for local prophylaxis via antibiotic-loaded bone cement[J].J Antimicrob Chemother,2017,72(2),410-416.
[13] BEALS R K,BRYANT R E.The treatment of chronic open osteomyelitis of the tibia in adults[J].Clin Orthop Relat Res,2005(433):212-217.
[14] AMERSTORFER F,FISCHERAUER S,SADOGHI P,et al.Superficial vancomycin coating of bone cement in orthopedic revision surgery:a safe technique to enhance local antibiotic concentrations[J].J Arthroplasty,2017,32(5):1618-1624.
[15] PENN-BARWELL J G,MURRAY C K,WENKE J C.Local antibiotic delivery by a bioabsorbable gel is superior to PMMA bead depot in reducing infection in an open fracture model[J].J Orthop Trauma,2014,28(6):370-375.
[16] OHTSUKA H,YOKOYAMA K,HIGASHI K,et al.Use of antibiotic-impregnated bone cement nail to treat septic nonunion after open tibial fracture[J].J Trauma,2002,52(2):364-366.
[17] YU X,WU H,LI J,et al.Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects[J].Int Orthop,2017,41(9):1851-1857.
[18] MALIZOS K,BLAUTH M,DANITA A,et al.Fast-resorbable antibiotic-loaded hydrogel coating to reduce post-surgical infection after internal osteosynthesis:a multicenter randomized controlled trial[J].J Orthop Traumatol,2017,18(2):159-169.
[19] WOON C Y L,CHONG K W,WONG M K,et al.Induced membranes—a staged technique of bone-grafting for segmental bone loss:a report of two cases and a literature review[J].J Bone Joint Surg Am,2010,92(1):196-201.
[20] WASKO M K,BORENS O.Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia:midterm results in 10 cases[J].Injury,2013,44(8):1057-1060.
[21] APARD T,BIGORRE N,CRONIER P,et al.Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing[J].Orthop Traumatol Surg Res,2010,96(5):549-553.
[22] THONSE R,CONWAY J D.Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects[J].J Bone Joint Surg Am,2008,90(Suppl 4):163-174.
[23] 張貴春,鄭潤(rùn)泉,鄒林,等.抗生素骨水泥聯(lián)合Ilizarov技術(shù)在長(zhǎng)骨感染性骨缺損治療中的應(yīng)用[J].實(shí)用骨科雜志,2019,25(1):25-28.
[24] ?ZTEM?R Z,S?MER Z,TUN? T,et al.The effect of low dose teicoplanin-loaded acrylic bone cement on biocompatibility of bone cement[J].Acta Microbiol Immunol Hung,2013,60(2):117-125.
[25] 王旭洋,楊勝松,黃雷,等.保留原鎖定接骨板聯(lián)合Orthofix單邊外固定架骨搬移治療股骨大段骨缺損[J].中醫(yī)正骨,2019,31(10):45-48.
[26] 趙漓波,胡文山,張群,等.骨搬運(yùn)和抗生素骨水泥結(jié)合膜誘導(dǎo)技術(shù)治療老年脛骨開放骨折后感染性骨不連患者的療效[J].中華老年多器官疾病雜志,2019,18(1):21-25.
[27] 金嘉誠.Masquelet技術(shù)在骨缺損修復(fù)中的應(yīng)用進(jìn)展[J].中醫(yī)正骨,2019,31(6):32-34.
[28] MASQUELET A C,BEGUE T.The concept of induced membrane for reconstruction of long bone defects[J].Orthop Clin North Am,2010,41(1):27-37.
[29] 紀(jì)振鋼,周大鵬,韓天宇,等.Masquelet膜誘導(dǎo)技術(shù)治療創(chuàng)傷性長(zhǎng)骨骨缺損的效果[J].中華創(chuàng)傷雜志,2019,35(2):128-135.
[30] CHOTEL F,NGUIABANDA L,BRAILLON P,et al.Induced membrane technique for reconstruction after bone tumor resection in children:a preliminary study[J].Orthop Traumatol Surg Res,2012,98(3):301-308.

相似文獻(xiàn)/References:

[1]肖善富,張喜善,于鳳珍.髕下小切口鋼絲紐扣式內(nèi)固定治療脛骨髁間隆突骨折[J].中醫(yī)正骨,2015,27(11):34.
[2]葛波涌,王玉波,王明太,等.交鎖髓內(nèi)釘內(nèi)固定治療脛骨干骨折的臨床研究[J].中醫(yī)正骨,2015,27(10):8.
 GE Boyong,WANG Yubo,WANG Mingtai,et al.Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(09):8.
[3]全先輝,萬春友,劉磊,等.Taylor空間支架外固定治療脛腓骨開放性骨折[J].中醫(yī)正骨,2015,27(10):30.
[4]何 濤.有限切開植骨鋼板內(nèi)固定治療 SchatzkerⅡ、Ⅲ型脛骨平臺(tái)骨折[J].中醫(yī)正骨,2015,27(09):22.
[5]何忠,黃宗權(quán),王強(qiáng),等.脛骨中下段螺旋形骨折合并后踝裂紋骨折的診治體會(huì)[J].中醫(yī)正骨,2015,27(09):28.
[6]李翰林,童培建.利福平聯(lián)合用藥配合保留假體清創(chuàng)治療 人工關(guān)節(jié)置換術(shù)后早期感染及低毒性感染[J].中醫(yī)正骨,2015,27(09):56.
[7]王慶東,李付彬,徐向峰,等.關(guān)節(jié)鏡下可吸收螺釘內(nèi)固定治療兒童脛骨髁間嵴骨折[J].中醫(yī)正骨,2015,27(12):52.
[8]李楠,李鋒.脛骨平臺(tái)骨折的手術(shù)治療進(jìn)展[J].中醫(yī)正骨,2015,27(12):78.
[9]張一鳴,張學(xué)民,陸洲.經(jīng)皮解剖型鎖定鋼板固定治療脛骨遠(yuǎn)端骨折[J].中醫(yī)正骨,2015,27(02):47.
[10]陳利軍,田野,劉文剛,等.非典型膝關(guān)節(jié)外傷后脛骨近端隱匿性骨折的影像診斷[J].中醫(yī)正骨,2015,27(06):26.
[11]魏英俊,徐克武,蔣宜偉,等.脛骨骨折內(nèi)固定術(shù)后感染的相關(guān)危險(xiǎn)因素[J].中醫(yī)正骨,2018,30(05):37.

備注/Memo

備注/Memo:
基金項(xiàng)目:遼寧省自然科學(xué)基金指導(dǎo)計(jì)劃項(xiàng)目(20180550361)
通訊作者:周大鵬 E-mail:[email protected]
更新日期/Last Update: 2020-09-20