INDUCED MEMBRANCE TECHNIQUE OF HOLLOW POROUS ANTIBIOTICIMPREGNATED BONE CEMENT FORMING IN VITRO AND LAVAGE IN VIVO FOR TREATMENT OF OSTEOMYELITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGHui ¹ , YINQudong ¹ , GUSanjun ¹ , XUYajun ¹ , SUNZhenzhong ¹ , RUIYongjun ¹ , WUYongwei ¹ ,  SHENYouyin ²

1. Department of Orthopaedics, Wuxi No. 9 People's Hospital, Wuxi Jiangsu, 214062, P. R. China;
2. Department of Orthopaedics, Wuxi Rende Hospital;

Corresponding?author：

SHENYouyin, Email: 13665150065@163.com

Keywords：

Osteomyelitis; Induced membrane technique; Bone cement forming in vitro; Lavage

DOI：

10.7507/1002-1892.20150299

Video：

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Objective To explore the effectiveness of induced membrane technique of hollow porous antibioticimpregnated bone cement forming in vitro and lavage in vivo for the treatment of osteomyelitis. Methods Between January 2010 and March 2014, 14 cases of osteomyelitis were treated by induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo after debridement at the first stage, then the bone cement with bone graft was replaced during the induced membrane after infection was controlled at the second stage. The time from first to second stage operation was 8-12 weeks (average, 10.2 weeks). There were 11 males and 3 females, aged 18 to 69 years (average, 39.2 years). According to Cierny-Mader classification of osteomyelitis, 2 cases were rated as intramedullary type, 5 cases as limited type, and 7 cases as diffusing type. The course of osteomyelitis was 3 months to 20 years, averaged 1.9 years. The healing of bone defect and the functionary recovery of adjacent joint were evaluated according to Paley's method. Results Debridement was performed for two times in 1 case, and for one time in 13 cases for control of bone infection at the first stage. All incisions healed by first intention after second stage. All patients were followed up 15-48 months (average, 13.4 months), with no recurrence of infection. All bone defects healed, and the clinical healing time was 4-5 months (average, 4.4 months). The results of bone healing grade were excellent in all cases at 1 year after operation; the functional recovery of adjacent joint at last follow-up was excellent in 4 cases, good in 8 cases, and fair in 2 cases, and the excellent and good rate was 85.7%. Conclusion Induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo for treatment of osteomyelitis has the advantages of high rate of elution of antibiotics, ease of lavage of medullary cavity, and no damage to induced membrane and bony interface between bone and bone cement when removing cement, it is effective for control of bone infection and repair of bone defect.

Citation： ZHANGHui, YINQudong, GUSanjun, XUYajun, SUNZhenzhong, RUIYongjun, WUYongwei, SHENYouyin. INDUCED MEMBRANCE TECHNIQUE OF HOLLOW POROUS ANTIBIOTICIMPREGNATED BONE CEMENT FORMING IN VITRO AND LAVAGE IN VIVO FOR TREATMENT OF OSTEOMYELITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1397-1400. doi: 10.7507/1002-1892.20150299 Copy

1.	魏亞恒. 慢性骨髓炎的綜合治療及進展. 中國骨與關節損傷雜志, 2012, 27(9):870-872.
2.	唐輝, 徐永清. 細菌生物膜與慢性骨髓炎. 中國修復重建外科雜志, 2010, 24(1):108-111.
3.	王上增. 抗生素骨水泥間置器治療髓內固定術后骨髓炎合并骨不連. 中國修復重建外科雜志, 2011, 25(8):972-975.
4.	Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am, 2010, 41(1):27-37.
5.	殷渠東, 孫振中, 顧三軍. 應用Masquelet技術修復骨缺損的研究進展. 中國修復重建外科雜志, 2013, 27(10):1273-1276.
6.	汪小華, 傅景曙, 沈杰, 等. 誘導膜技術治療脛骨創傷后骨髓炎. 中華創傷雜志, 2015, 31(4):299-302.
7.	魏波, 王宸, 李賀. 骨水泥不同時相負載抗生素的研究. 中國組織工程研究, 2012, 16(25):4581-4585.
8.	徐建強, 周密, 樊麗潔, 等. 抗生素骨水泥填塞治療慢性跟骨骨髓炎. 中國骨與關節損傷雜志, 2014, 29(10):1070-1071.
9.	雷鳴, 王敏, 張催. 萬古霉素骨水泥對骨折內固定術后髓內感染的療效觀察. 抗感染藥學, 2014, 11(5):538-540.
10.	Paley D, Herzenberg JE, Paremain G, et al. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg (Am), 1997, 79(10):1464-1480.
11.	Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1):97-102.
12.	章曉云, 陳躍平, 龍飛攀, 等. 抗生素骨水泥治療創傷性脛骨骨髓炎的臨床療效分析. 中國骨與關節損傷雜志, 2015, 30(4):371-373.
13.	Makridis KG, Theocharakis S, Fragkakis EM, et al. Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report. Foot Ankle Surg, 2014, 20(2):e19-22.
14.	Polyzois VD, Stathopoulos IP, Lampropoulou-Adamidou K, et al. Strategies for managing bone defects of the lower extremity. Clin Podiatr Med Surg, 2014, 31(4):577-584.
15.	Blair C, Simela AT, Cross BJ. A challenging case of limb salvage requiring a combination of composite fixation and masquelet technique to address significant segmental bone loss. Case Rep Orthop, 2015, 2015:369469.
16.	朱宏剛, 景凱, 王玉忠, 等. Masquelet技術在股骨骨髓炎大段骨缺損治療中的應用. 醫學與社會, 2015, 28(5):188.
17.	趙寶成, 袁天祥, 馬寶通, 等. 局部應用抗生素緩釋系統治療創傷后及內固定相關骨感染臨床療效觀察. 中國矯形外科雜志, 2015, 23(10):877-881.
18.	謝肇. 四肢長骨創傷后骨髓炎診斷與治療的難點及挑戰. 中華創傷雜志, 2015, 31(4):289-292.
19.	祝勇剛, 張大偉, 趙廣躍, 等. 抗生素骨水泥聯合自體骨移植及環形外固定架修復骨髓炎后脛骨缺損. 中國組織工程研究, 2015, 19(25):3942-3946.

1. 魏亞恒. 慢性骨髓炎的綜合治療及進展. 中國骨與關節損傷雜志, 2012, 27(9):870-872.
2. 唐輝, 徐永清. 細菌生物膜與慢性骨髓炎. 中國修復重建外科雜志, 2010, 24(1):108-111.
3. 王上增. 抗生素骨水泥間置器治療髓內固定術后骨髓炎合并骨不連. 中國修復重建外科雜志, 2011, 25(8):972-975.
4. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am, 2010, 41(1):27-37.
5. 殷渠東, 孫振中, 顧三軍. 應用Masquelet技術修復骨缺損的研究進展. 中國修復重建外科雜志, 2013, 27(10):1273-1276.
6. 汪小華, 傅景曙, 沈杰, 等. 誘導膜技術治療脛骨創傷后骨髓炎. 中華創傷雜志, 2015, 31(4):299-302.
7. 魏波, 王宸, 李賀. 骨水泥不同時相負載抗生素的研究. 中國組織工程研究, 2012, 16(25):4581-4585.
8. 徐建強, 周密, 樊麗潔, 等. 抗生素骨水泥填塞治療慢性跟骨骨髓炎. 中國骨與關節損傷雜志, 2014, 29(10):1070-1071.
9. 雷鳴, 王敏, 張催. 萬古霉素骨水泥對骨折內固定術后髓內感染的療效觀察. 抗感染藥學, 2014, 11(5):538-540.
10. Paley D, Herzenberg JE, Paremain G, et al. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg (Am), 1997, 79(10):1464-1480.
11. Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1):97-102.
12. 章曉云, 陳躍平, 龍飛攀, 等. 抗生素骨水泥治療創傷性脛骨骨髓炎的臨床療效分析. 中國骨與關節損傷雜志, 2015, 30(4):371-373.
13. Makridis KG, Theocharakis S, Fragkakis EM, et al. Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report. Foot Ankle Surg, 2014, 20(2):e19-22.
14. Polyzois VD, Stathopoulos IP, Lampropoulou-Adamidou K, et al. Strategies for managing bone defects of the lower extremity. Clin Podiatr Med Surg, 2014, 31(4):577-584.
15. Blair C, Simela AT, Cross BJ. A challenging case of limb salvage requiring a combination of composite fixation and masquelet technique to address significant segmental bone loss. Case Rep Orthop, 2015, 2015:369469.
16. 朱宏剛, 景凱, 王玉忠, 等. Masquelet技術在股骨骨髓炎大段骨缺損治療中的應用. 醫學與社會, 2015, 28(5):188.
17. 趙寶成, 袁天祥, 馬寶通, 等. 局部應用抗生素緩釋系統治療創傷后及內固定相關骨感染臨床療效觀察. 中國矯形外科雜志, 2015, 23(10):877-881.
18. 謝肇. 四肢長骨創傷后骨髓炎診斷與治療的難點及挑戰. 中華創傷雜志, 2015, 31(4):289-292.
19. 祝勇剛, 張大偉, 趙廣躍, 等. 抗生素骨水泥聯合自體骨移植及環形外固定架修復骨髓炎后脛骨缺損. 中國組織工程研究, 2015, 19(25):3942-3946.

Chinese Journal of Reparative and Reconstructive Surgery

INDUCED MEMBRANCE TECHNIQUE OF HOLLOW POROUS ANTIBIOTICIMPREGNATED BONE CEMENT FORMING IN VITRO AND LAVAGE IN VIVO FOR TREATMENT OF OSTEOMYELITIS

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