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Objective To explore the clinical application of the multi-network anatomical lavage on the treatment of chronic osteomyelitis after fracture surgery. Methods A retrospective analysis of 40 patients (41 sites) with chronic osteomyelitis after fracture surgery was performed from June 2006 to December 2008. There were 35 males and 5 females with an average of 42.7 years (range, 16-68). All 40 cases were treated with debridement, closing the cavity, and placing the multi-tube drainage network anatomical catheter lavage system. At the same time, sensitive antibiotics were used for 3 to 4 weeks. Rechecks were scheduled every 3 months after operation, including wound healing, X-ray presentation, ESR and C-reactive protein.Cure criteria depends on the conditions of the inflammation when the lavage treatment was over, and whether it relapsed six months after operation, including wound healing, systemic symptoms, ESR and C-reactive protein. Results Judged by the clinical outcomes when the lavage treatment was over and six months after operation, the effects were categorized into 3 levels, including excellent in 37 cases with primary wound healing, and without relapse six months later;, good in 2 with poor wound healing, the wound healed after a period of treatment without recurrence; poor in one with recurrent sinus infection and a prolonged unhealed wound, after another operation he was healed. 36 cases were treated with bone graft and internal fixation operation, and the fractures were healed after surgery, the fractures were healed directly in 4 cases without bone graft. The patients were followed up for an average of 43.2 months (range, 30-50) after operation, and none relapsed. Conclusion The multi-tube drainage network anatomical method is feasible and effective on the treatment of chronic osteomyelitis after fracture surgery with a high cure rate.
RESUMO
BACKGROUND: Autologous bone marrow transplantation (ABMT) has been widely used in treatment of the malunion of fracture, but this treatment to cure malunion of fracture induced by infection is still not consistent.OBJECTIVE: To observe the application and clinical outcome of ABUT for the malunion of fracture induced by infection.DESIGN, TIME AND SETTING: A retrospective analysis. The patients were all enrolled at Department of Orthopaedics in the Third Affiliated Hospital of Hebei Medical University from January 2001 to January 2006. PARTICIPANTS: A total of 19 patients with malunion of fracture induced by infection, including 13 males and 6 females aged from 18 to 50 years, with an average of 36. The lesioned site contained fracture of tibia 10, fracture of femur 5, fracture of ulna 2 and fracture of humerus 2. Among them, there were 6 cases with bone defect, 9 cases with bone fracture delayed union and 4 cases with bone fracture disunion.METHODS: Nineteen patients treated with percutaneous ABUT. Among the 19 cases, 12 patients received the transplant 3 weeks after infection was under controlled, and other 8 patients received the transplant following autologous bone transplantation.MAIN OUTCOME MEASURES: After ABMT, all patients were checked using X-ray regularly, the pacing of bone union was traced through observing the growth of callus, and the side reaction was also detected.RESULTS: Totally 19 patients were included in the follow-up visit, and 15 cases of them achieved bony union. Clinical healing time was 7-20 weeks. The patients had no obvious discomforts except local gas pains when injecting and at pristine time after injection. Five patients had a small quantity of exudation. No infection relapse or soft tissue ossification were observed at the injection position. Four patients had not achieved bony union, the reason was that bone defect in 2 patients exceed 2 cm; fracture disunion with pseudoarticulation formatted in one patient, the sclerous broken ends of fractured bone was more than 2 cm; another patient's external fixation displaced, we adjusted it and the bone healed after 12 weeks. Three patients received autoallergic ilium bone transplantation in the second time of operation, the fractured bone got bony union. CONCLUSION: ABMT by percutaneous injection into malunion site can induce ossification, repair bone fracture and bone defects. The clinical application is simple and exhibits small wounds without complications. Especially ABMT is effective for the patient with the malunion of fracture induced by infection.