长骨骨折内固定术后隐性感染的诊断及处理.DOCVIP

临床医学论文-长骨骨折内固定术后隐性感染的诊断及处理 【摘要】? 探讨长骨骨折内固定术后隐性感染的诊断及处理方法。［方法］对13例长骨骨折内固定术后隐性感染的患者，采用病灶清除，灌洗引流，其中8例取出内固定物改外固定架固定，5例保留原内固定物。3例Ⅰ期植骨。Ⅱ期内固定加植骨术7例。术后应用抗生素2～3周。［结果］经8～48个月随访，平均23.5个月。骨折愈合11例。部分愈合1例，不愈合1例。1例出现窦道，2例感染复发。［结论］长骨骨折内固定术后隐性感染存在骨缺损、骨折不愈合或骨愈合不良，需要手术治疗。感染轻者病灶清除后可保留内固定物。感染重或内固定物松动者行病灶清除同时取出内固定物改外固定架固定。X线片表现是诊断骨折内固定术后隐性感染的重要依据。 【关键词】? 骨折内固定术 感染 骨折 不愈合 外固定器 ?????? Abstract：［Objective］To study diagnosis and treatment of insidious infection after the internal fixation of long bone fracture.［Method］Thirteen patients with insidious infection after internal fixation of long bone fracture were treated with irrigation after debridment. Among the 13 cases 8 fractures were dislodged internal fixation and then were fixed with the external fixation. 5 fractures were remained the internal fixation and were instilled after debridment. All of the patients were given with antibiotics for 2～3 weeks after operation.［Result］All the 13 patients were followed up. The followranged from 8 to 48 months with an average of 23.5 months. Among the thirteen patients 11 fracturedbone had bony union, one nonunion and one case had fistula, Infection relapsed in two patients.［Conclusion］Bone defects, fracture nonunion often occur on patients who have insidious infection after internal fixation of long bone fracture. These patients need to be operated. In slight infections fracture can be remained after debridement. Fractures with seriously infectious have to dislodge internal fixation and to be fixed with made according to its radiographic changes. ??? Key words：internal fixation;? Insidious infection;? fracture；? Nonunion；? External fixation ???? 感染是骨折内固定术后的严重并发症，往往造成骨不愈合，或延迟愈合。而骨折内固定术后隐性感染无症状，常延误诊断治疗。自2001年1月～2006年1月作者收治长骨骨折内固定术后隐性感染13例。 ??? 1? 材料与方法 ??? 1.1? 病例资料 ??? 本组13例，男9例，女4例。股骨骨折8例，粗隆间骨折2例，尺骨骨折1例，肱骨骨折1例，胫骨骨折1例。其中闭合性骨折11例，开放性骨折2例。年龄18～50岁，平均36岁。闭合性骨折Ⅰ期切开复位内固定术，开放性骨折清创缝合内固定术。交锁钉髓内固定8例(股骨6例，胫骨1例，肱骨1例)。钢板固定3例(股骨2例，尺骨1例)。动力髋固定2例为粗隆间骨折。骨折不愈合8例，骨缺损或骨愈合不良2例。初次手术距就诊时间为3～18个月，平均8.3个月。术前明确诊断9例，术中发现脓