中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (7): 1023-1030.doi: 10.12307/2023.026

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

3D打印模具制备抗生素骨水泥髓内钉治疗下肢长骨感染

赵  伟，冯  卫，杨铁翼，任  伟，王玉鑫，吕慧成，常志强，冯晓东，王紫横，郭世炳   

  1. 内蒙古医科大学第二附属医院骨科，内蒙古自治区骨科研究所，内蒙古自治区呼和浩特市  010030
  • 收稿日期:2021-08-26 接受日期:2022-01-15 出版日期:2023-03-08 发布日期:2022-07-18
  • 通讯作者: 郭世炳，主任医师，教授，内蒙古医科大学第二附属医院骨科，内蒙古自治区骨科研究所，内蒙古自治区呼和浩特市 010030
  • 作者简介:赵伟，男，1983年生，内蒙古自治区乌兰察布市人，汉族，2013年内蒙古医科大学毕业，硕士，副主任医师，主要从事急慢性骨感染和骨髓炎的临床与基础研究

Antibiotic bone cement intramedullary nail prepared using 3D printed mold for the treatment of long bone infection in lower limbs

Zhao Wei, Feng Wei, Yang Tieyi, Ren Wei, Wang Yuxin, Lyu Huicheng, Chang Zhiqiang, Feng Xiaodong, Wang Ziheng, Guo Shibing   

  1. Department of Orthopedic, Second Affiliated Hospital of Inner Mongolia Medical University, Orthopedic Institute of Inner Mongolia Autonomous Region, Hohhot 010030, Inner Mongolia Autonomous Region, China
  • Received:2021-08-26 Accepted:2022-01-15 Online:2023-03-08 Published:2022-07-18
  • Contact: Guo Shibing, Chief physician, Professor, Department of Orthopedic, Second Affiliated Hospital of Inner Mongolia Medical University, Orthopedic Institute of Inner Mongolia Autonomous Region, Hohhot 010030, Inner Mongolia Autonomous Region, China
  • About author:Zhao Wei, Master, Associate chief physician, Department of Orthopedic, Second Affiliated Hospital of Inner Mongolia Medical University, Orthopedic Institute of Inner Mongolia Autonomous Region, Hohhot 010030, Inner Mongolia Autonomous Region, China

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摘要：

文题释义：
骨感染：骨折相关感染属于严重的并发症，如不能及时有效控制感染，极易发展为慢性骨髓炎，导致感染迁延不愈、骨折不愈合、清创后感染复发和致残。控制骨感染的主要手段是对窦道和坏死组织及髓腔内进行清创，以及全身和局部使用抗生素。骨水泥是目前应用最好的抗生素载体，因其可根据需要制成珠、垫片、涂层或棒等不同形状成为抗感染最广泛使用的材料。
骨水泥：即聚甲基丙烯酸甲酯，1927年由HILL和CRAWFOLD发明，目前已广泛用于人工关节置换、骨缺损填充等骨科领域。它是一种用于填充骨与植入物间隙或骨腔并具有自凝特性的生物材料。调配骨水泥时，将粉剂与液剂混合后搅拌，在聚合过程中经历了湿沙期、粘丝期、面团期及固化期4个阶段。

背景：由于抗生素水泥棒或钉在制备技术、术中操作中存在很多问题，其应用仍然受到限制。
目的：探讨应用3D打印模具制备的抗生素骨水泥髓内钉髓腔植入联合扩髓清创治疗下肢长骨骨感染的临床疗效。
方法：回顾性分析2018年10月至2020年10月采用3D技术打印模具制作的抗生素骨水泥髓内钉髓腔植入治疗股骨和胫骨感染患者16例，其中股骨10例，胫骨6例。根据Cierny-Mader骨感染分型，Ⅲ型4例，Ⅰ型+Ⅲ型7例，Ⅰ型+Ⅳ型5例。首次(手术)治疗至初始感染时间0.5-120个月，感染持续时间为0.5-118个月。对于髓内钉固定患者，取出髓内钉后对存在感染的骨折端以及交锁螺钉处的软组织瘢痕、肉芽组织和死骨彻底清除，有窦道和软组织脓肿者对感染累及的软组织切除；使用软钻扩髓去除髓腔内坏死及炎性组织，并送检，反复冲洗髓腔后植入抗生素骨水泥髓内钉。对于非髓内钉固定或无固定患者，感染断端或局灶型感染处切开，将窦道和感染的软组织一并切除，按照股骨或胫骨标准髓内钉固定操作步骤开口扩髓，其他过程同前。
结果与结论：①患者均随访12-24个月，无一例感染复发和并发症；②1例骨折畸形愈合，1例股骨骨折感染者膝关节活动范围50°；③6例患者在取钉时获得的髓内组织细菌培养和组织学检查均为阴性；④所有患者住院时间7-53个月；医疗费用0.60万-4.94万元；⑤结果表明，应用扩髓清创联合抗生素骨水泥髓内钉髓腔植入是治疗长骨骨感染的有效方法。应用此技术治疗下肢长骨感染可以缩短手术时间，显著降低医疗费用。证据等级：治疗性研究Ⅳ级。

https://orcid.org/0000-0001-5700-4035 (赵伟) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 股骨, 胫骨, 骨折相关感染, 骨髓炎, 髓腔感染, 抗生素骨水泥

Abstract: BACKGROUND: Due to many problems in the preparation technology and intraoperative operation of antibiotic cement rods or nails, their applications are still limited. 
OBJECTIVE: To explore the clinical effect of antibiotic bone cement intramedullary nail implantation prepared using 3D printed molds combined with debridement in the treatment of postoperative infection in the lower extremities long bone infection. 
METHODS: From October 2018 to October 2020, 16 patients with femoral and tibial infection were treated by antibiotic bone cement intramedullary nail medullary cavity implantation made of 3D printed mold. There were 10 cases of femur and 6 cases of tibia. According to Cierny Mader’s classification of bone infection, there were 4 cases of type III, 7 cases of type I + type III, and 5 cases of type I + type IV. The time from the first (surgical) treatment to the initial infection was 0.5-120 months and the duration of infection was 0.5-118 months. In the intramedullary nail fixation group, the soft tissue scar, granulation tissue and dead bone at the infected fracture end and the interlocking screw were completely removed after the removal of intramedullary nail. The soft tissue involved in infection was removed for patients with sinuses and soft tissue abscesses. The necrotic and inflammatory tissues in the medullary cavity were removed with soft drill and examined. Antibiotic bone cement intramedullary nail was implanted after repeated irrigation of the medullary cavity. In the non-intramedullary nail fixation or non-fixation group, the infected broken end or focal infection site was cut open. The sinuses and infected soft tissue were removed together. The pulp was expanded according to the standard procedures of femoral or tibial intramedullary nail fixation. The other procedures were the same as before. 
RESULTS AND CONCLUSION: (1) All patients were followed up for 12-24 months. There was no recurrence of infection or complications. (2) One case was infected with malunion of fracture. The range of motion of the knee joint was 50 degrees in a patient with femoral fracture. (3) Bacterial culture and histological examination of intramedullary tissue obtained from six patients with bone cement nail removal were all negative. (4) The hospital stay of all patients was 7-53 months. The medical expenses ranged from 6 000 to 49 400 yuan. (5) It is concluded that a medullary debridement in combination with antibiotic bone cement intramedullary nail implantation is an effective treatment for long bone infection. The application of this technique in the treatment of lower limb long bone infection can shorten the operation time and greatly reduce the medical cost. Level of evidence: therapeutic research level IV.

Key words: femur, tibia, fracture associated infection, osteomyelitis, intramedullary infection, antibiotic bone cement

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