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Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.
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BACKGROUND:Clinical resection of thoracolumbar spinal tumor has a great impact on the spinal stability. Positive internal fixation is required clinicaly in order to maintain the spinal stability. The use of titanium mesh implantation can provide a firm internal fixation folowing resection of tumors. OBJECTIVE:To explore the spinal stability undergoing titanium mesh implantation with internal fixation folowing thoracolumbar tumor resection. METHODS:Twenty-four patients with thoracolumbar tumor admitted at the Central Hospital of Suining City from September 2013 to September 2014 were randomly selected and given tumor resection folowed by titanium mesh implantation with internal fixation. After treatment, patients were folowed up for 1-12 months to observe and analyze the neural functional recovery and spinal stability of the patients. RESULTS AND CONCLUSION:Al the 24 patients successfuly completed the operation treatment, and there was no case of death at the end of folow-up. During the folow-up, patient's clinical symptoms and neural function were significantly relieved, and Frankel classification was significantly improved after treatment. Regular X-ray examination showed that there was no change in the position of titanium mesh and anterior internal fixation system. There was also no titanium mesh colapse, internal fixation fracture and loosening, and the spinal stability was stil excelent. These findings indicate that patients were not changed, and did not appear because the amount of loose, good spinal stability. Resection of thoracolumbar tumors showed that the thoracolumbar spinal reconstruction with titanium mesh implantation combined with internal fixation folowing tumor resection can obtain good clinical effect and excelent biocompatiblity.
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Objective To summarize the clinical effect of transpedicular Dynesys dynamic fixation for treating degenerative lum-bar disease.Methods 34 cases of degenerative lumbar disease were treated by transpedicular Dynesys dynamic fixation and per-formed the retrospective analysis.The VAS score of lumbago was (6.01±0.98),the VAS score of skelalgia was (5.47±0.63), ODI was(64.47 ±2.06)%.The cranial intervertebral space height in the fixed segment was(12.01±1.08)mm,the intervertebral space height in the fixed segment was(11.47±1.13)mm;the caudal intervertebral space height in the fixed segment was(11.95± 1.06)mm;the intervertebral motion range of the cranial segment in the fixed segment was(8.11±1.21)°,the intervertebral motion range of the fixed segment was(8.47±1.63)°,the intervertebral motion range of the caudal segment in the fixed segment(7.86± 1.36)°.39 intervertebral spaces in 27 cases adopted the decompression combined with Dynesys fixation,the single intervertebral space in 7 cases was performed with Dynesys fixation alone.Results All patients smoothly pulled through the perioperative period. No complications of wound infection,leakage of cerebralspinal fluid and nerve inj ury occurred,wound infection,leakage of cerebro-spinal fluid and nerve injury.All patients were followed up for 25-45 months,averaged 31.2 months.The VAS score of lumbago at the last time of follow up was (1.85±1.03),the VAS score of skelalgia was(1.54±0.18),ODI was(11.42±1.51)%,the cranial intervertebral space height in the fixed segment was(11.85±0.93)mm,the intervertebral space height of the fixed segment was (11.34±1.02)mm,the caudal intervertebral space height in the fixed segment was(11.62±0.97)mm;the intervertebral space motion range of the cranial segment in the fixed segment was(8.85 ± 1.33)°,the intervertebral space motion range of thye fixed segment was(4.54±1.78)°,the intervertebral space motion range of the caudal segment in the fixed segment was(7.62±1.21)°. Conclusion Transpedicular Dynesys dynamic fixation for treating degenerative lumbar disease can confine and reserve the motion range of the fixed segment,lessen lumbago and skelalgia,improve the function of waist and leg and have no obvious influence on the adjacent segment,its short-term therapeutic effect is satisfactory,but long-term therapeutic effect needs the clinical observation of long time and large amount cases.