| BackgroundThe treatment of infected bone defects has always been a major problem in the Department of orthopedics.It is usually caused by severe trauma,surgical infection or osteomyelitis.The treatment of the disease is very difficult,the treatment time is long,and the cure rate is very low.The basis of controlling bone infection is thorough debridement,followed by local treatment after debridement.The traditional view is that the external fixator is the best choice for stabilization in the treatment of infected bone defects,it can avoid bacterial biofilm formation caused by the presence of metal foreign bodies.Because bacterial biofilm is one of the important causes making infection difficult to control,internal fixation could be easily attached by bacteria to become a new source of infection.The presence of external fixation is conducive to the control of bone infection.However,the external fixator did not solve the problem of poor treatment effect of bone infection,and there are inherent limitations and many complications,such as nail infection,poor stability,joint stiffness,poor patient tolerance and so on.The application of internal fixation can avoid the above defects of external fixation frame,but under the guidance of the existing concept,the use of internal fixation in the case of bone infection is taboo.ObjectiveTo observe the clinical effect of locking plate coated with antibiotic bone cement in the treatment of long bone infected bone defects in extremities.To explore the application conditions of the treatment of infectious bone defects of long bone by internal fixation with antibiotic cement and locking plateMethodsA retrospective analysis was performed on the cases of infected bone defects in the long bones of extremities admitted to the first affiliated hospital of the Army Medical University from January 2012 to December 2017.All patients were treated with induced membrane technique.According to the different fixation methods in the first stage of operation,they were divided into internal fixation group(temporary locking plate coated with antibiotic bone cement)and external fixation group(temporary fixation with external fixator).The infection cure rate,bone healing rate,bone healing time and complications of the two groups were recorded and compared.ResultsA total of 286 patients were included in the study,194 in the internal fixation group and92 in the external fixation group.All patients were followed up for an average of 39.12±15.0months.Internal Fixation Group(194):There were 163 males and 31 females with an average age of 38.0±13.3 years.The infection sites included 7 humerus,4 ulna and radius,81 femurs,100 tibias and 2 fibulas.There were 37 cases of haematogenous osteomyelitis,157 cases of post-traumatic osteomyelitis,102 cases of open fracture and 55 cases of closed fracture.According to the Cierny-Mader anatomic classification,there were 51 patients with type III and 143 patients with type VI.According to the Cierny-Mader physiologic classification,there were 109 patients of class A and 85 patients of class B.Among the 194 patients,122(62.9%)had positive bacterial isolations.The length of bone defect was 7.54±3.90cm on average.External Fixation Group(92):There were 82 males and 10 females with an average age of 40.1±12.0 years.The infection sites included 1 humerus,12 femurs,79 tibias.There were13 cases of haematogenous osteomyelitis,79 cases of post-traumatic osteomyelitis,51 cases of open fracture and 28 cases of closed fracture.According to the Cierny-Mader anatomic classification,there were 34 patients with type III and 58 patients with type VI.According to the Cierny-Mader physiologic classification,there were 49 patients of class A and 43 patients of class B.Among the 92 patients,68(73.9%)had positive bacterial isolations.The length of bone defect was 6.56±4.10cm on average.There was no significant difference between the two groups in gender,age,cause of bone infection,Cierny-Mader anatomical classification,Cierny-Mader patient classification,smoking,presence of sinus,length of bone defect,and positive rate of bacterial culture during the first stage operation.There were 16(8.2%)cases of infection recurrence in the internal fixation group and 12(13.0%)cases in the external fixation group.There was no significant difference(?~2=1.625,p=0.202>0.005).There were 24(12.4%)cases of infection recurrence in the internal fixation group and 6(6.5%)cases in the external fixation group.The difference was not statistically significant(?~2=2.274,p=0.132>0.005).There were 182(93.8%)cases in internal fixation group and 88(95.7%)cases in external fixation group.The difference was not statistically significant(?~2=0.376,p=0.540>0.05).The healing time of the internal fixation group and the external fixation group was 5.27±1.71 months and 5.47±1.73 months respectively,there was no significant difference(t=-0.884,p=0.377>0.05).There was no significant difference between the two groups in wound healing,post ilium infection and complications of fixation loosening(p>0.05).ConclusionThe clinical effect of locking plate coated with antibiotic bone cement in the treatment of long bone infected bone defects in extremities as a stable way is reliable compared with the traditional external fixator,there is no significant difference in infection control rate,bone healing rate and complication rate.At the same time,it avoids the disadvantages and limitations of the external fixator,and realizes the simultaneous treatment of infection and functional rehabilitation.In this study,clinical cases have confirmed that internal fixation is feasible after debridement.Thorough debridement is the basic premise,and high concentration of sensitive antibiotic bone cement is an important guarantee. |
