| The fractures caused by all kinds of High-Energy injuries become more and more as the development of society, transport and construction, especially are some open fractures. It's difficult to control the rate of infection in the treatment of the fractures. It's difficult and it will cost a long time to heal infected bone defect because of the existence of both infection and bone defect. The disease always results in muscular atrophy and segmental scars which bring great inconvenience to the patient's daily live and sometimes will need a amputation if the infection is out of control. At present there are two therapies to treat the disease which are traditional therapy and implantation of ALAC.We always take the therapy of implantation of ALAC to cure infected bone defect which can supply a high local concentrations of antibiotics with minimal systemic levels. Traditional therapy is less effective than the implantation of ALAC so we abandon traditional therapy instead of the implantation of ALAC.However,the irregular use of antibiotics and bacterial resistance to antibiotics reduce the rate of infection of the single-type gentamicin-loaded bone cement. Clinical research of other types of ALAC and complex types ALAC develop now base on above situation. But the research of complex types of ALAC is not enough. We take the method of VCM-Simplex ALAC to cure infected bone defect in China-Japan Union Hospital Of JiLin University and we also have a good clinical effect on controlling of infection. The article mainly observes the differences of the two methods and different antibiotic-loaded bone cements to find out a more effective treatment.Materials and Methods The retrospective study focuses on 32 patients with infected bone defect who agree to take the treatment of implantation of ALAC from February 2007 to Sep 2009. 45 cases of treatment group with implantation of VCM-Simplex ALAC, 17 males and 7 females; aged 15-68 years, the average age is 48.5 years, which includes 1 patient with humeral fracture, 6 patients with hip fracture, 6 patients with femur fracture,8 patients with tibia fracture, 1 patient with the disease of ankle,1 patient with both tibia fracture and fibula fracture. There are 8 old patients aged beyond 60 years, 3 patients with diabetes, heart disease and hypertension in the group, 1 patient after the surgery of femoral thrombosis and compartment syndrome.Besides, 14 patients have already treated by one or more times by the traditional method. The other treatment include 8 case patients who agree with the method of implantation of single-type gentamicin-loaded bone cement,6 males and 2 females, aged 19-69 years, the average age is 49.4 years. The group includes 1 patient with the disease of ilium, 4 patients with the disease of hip,1 patient with the disease of knee ,2 patients with the disease of tibia. There are 3 old patients aged beyond 60 years, 1 patient with the disease of renal inadequacy and other parts of infection. Besides, there are 3 patients have already take one or more operations of traditional treatment. Treatment We make preoperative routine exam and bacterial culture as well as sensitivity test. Application of prophylactic antibiotics is carried out three days or 5 five days before the operation. There are 32 patients in total in this search who agree to take the treatment of implantation of PMMA antibiotic-loaded bone cement. There are 24 patients in treatment group who agree to the treatment of implantation of VCM-Simplex ALAC. The other group has 8 patients who agree to take the treatment of implantation of Single-Type gentamicin-loaded bone cement. We also make some postoperative examinations for patients such as x-rays of bone , complete blood picture,ESR and CRP. We also take care of the cut and giving intravenous antibiotics for the patients.Result The treatment group are followed-up 4-43 months with a mean of 15.6 months and the Single-Type gentamicin-loaded bone cement group are followed-up 6-39 months with a mean of 25.3 months. There are 17 patients take the treatment of implantation of ALAC who have ever taken the treatment of traditional therapy. They are followed-up 5-39 months with a mean of 17.8 months. One patient of the 17 patients who were treatment by traditional therapy is cured and the curative rate of the traditional therapy is 5.9%.One patient got infected by other reason. The 17 patients were treated with the method of implantation of ALAC in our hospital and 15 patients are cured .The curative rate of the group is 88.2%. 21 patients of the 24 patients are cured in the treatment group and the curative rate is 87.5% .There are 3 patients cured in the group of 8 patients who agree with the method of implantation of Single-Type gentamicin-loaded bone cement. And the curative rate of the group is 37.5%. Statistics processing show that there is difference in the rate of infection controlling between the two therapies. There is difference in curative rate for infection between the two groups.Conclusion 1.Thorough débridement combine implantation of ALAC can led to a good clinical effect in the treatment of infected bone defect, what's more, an accurate result of the bacterial culture and sensitivity test will play an important role in the treatment of the disease.2.The implantation of ALAC have a batter clinical effect than traditional therapy which can supply a high local concentrations of antibiotics with minimal systemic levels. It provides a good foundation for two-stage bone graft because it can control infection and fill the part of bone defect with ALAC.3.VCM-Simplex ALAC is a better choice than Single-Type gentamicin-loaded bone cement in the treatment of infected bone defect.4. Postoperative complications of the implantation of ALAC could happen and it will cause the fracture of bone cement so we should control the dose of antibiotics within ALAC.And the appropriate rate of antibiotics/bone cement is 1/20. 5.The model of mixing ALAC in the vacuum have a less influence than manual operation in the Mechanical Characteristics and Biological Characteristics.
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