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.	魏亚恒. 慢性骨髓炎的综合治疗及进展. 中国骨与关节损伤杂志, 2012, 27(9):870-872.
2.	唐辉, 徐永清. 细菌生物膜与慢性骨髓炎. 中国修复重建外科杂志, 2010, 24(1):108-111.
3.	王上增. 抗生素骨水泥间置器治疗髓内固定术后骨髓炎合并骨不连. 中国修复重建外科杂志, 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.	殷渠东, 孙振中, 顾三军. 应用Masquelet技术修复骨缺损的研究进展. 中国修复重建外科杂志, 2013, 27(10):1273-1276.
6.	汪小华, 傅景曙, 沈杰, 等. 诱导膜技术治疗胫骨创伤后骨髓炎. 中华创伤杂志, 2015, 31(4):299-302.
7.	魏波, 王宸, 李贺. 骨水泥不同时相负载抗生素的研究. 中国组织工程研究, 2012, 16(25):4581-4585.
8.	徐建强, 周密, 樊丽洁, 等. 抗生素骨水泥填塞治疗慢性跟骨骨髓炎. 中国骨与关节损伤杂志, 2014, 29(10):1070-1071.
9.	雷鸣, 王敏, 张催. 万古霉素骨水泥对骨折内固定术后髓内感染的疗效观察. 抗感染药学, 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.	章晓云, 陈跃平, 龙飞攀, 等. 抗生素骨水泥治疗创伤性胫骨骨髓炎的临床疗效分析. 中国骨与关节损伤杂志, 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.	朱宏刚, 景凯, 王玉忠, 等. Masquelet技术在股骨骨髓炎大段骨缺损治疗中的应用. 医学与社会, 2015, 28(5):188.
17.	赵宝成, 袁天祥, 马宝通, 等. 局部应用抗生素缓释系统治疗创伤后及内固定相关骨感染临床疗效观察. 中国矫形外科杂志, 2015, 23(10):877-881.
18.	谢肇. 四肢长骨创伤后骨髓炎诊断与治疗的难点及挑战. 中华创伤杂志, 2015, 31(4):289-292.
19.	祝勇刚, 张大伟, 赵广跃, 等. 抗生素骨水泥联合自体骨移植及环形外固定架修复骨髓炎后胫骨缺损. 中国组织工程研究, 2015, 19(25):3942-3946.

1. 魏亚恒. 慢性骨髓炎的综合治疗及进展. 中国骨与关节损伤杂志, 2012, 27(9):870-872.
2. 唐辉, 徐永清. 细菌生物膜与慢性骨髓炎. 中国修复重建外科杂志, 2010, 24(1):108-111.
3. 王上增. 抗生素骨水泥间置器治疗髓内固定术后骨髓炎合并骨不连. 中国修复重建外科杂志, 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. 殷渠东, 孙振中, 顾三军. 应用Masquelet技术修复骨缺损的研究进展. 中国修复重建外科杂志, 2013, 27(10):1273-1276.
6. 汪小华, 傅景曙, 沈杰, 等. 诱导膜技术治疗胫骨创伤后骨髓炎. 中华创伤杂志, 2015, 31(4):299-302.
7. 魏波, 王宸, 李贺. 骨水泥不同时相负载抗生素的研究. 中国组织工程研究, 2012, 16(25):4581-4585.
8. 徐建强, 周密, 樊丽洁, 等. 抗生素骨水泥填塞治疗慢性跟骨骨髓炎. 中国骨与关节损伤杂志, 2014, 29(10):1070-1071.
9. 雷鸣, 王敏, 张催. 万古霉素骨水泥对骨折内固定术后髓内感染的疗效观察. 抗感染药学, 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. 章晓云, 陈跃平, 龙飞攀, 等. 抗生素骨水泥治疗创伤性胫骨骨髓炎的临床疗效分析. 中国骨与关节损伤杂志, 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. 朱宏刚, 景凯, 王玉忠, 等. Masquelet技术在股骨骨髓炎大段骨缺损治疗中的应用. 医学与社会, 2015, 28(5):188.
17. 赵宝成, 袁天祥, 马宝通, 等. 局部应用抗生素缓释系统治疗创伤后及内固定相关骨感染临床疗效观察. 中国矫形外科杂志, 2015, 23(10):877-881.
18. 谢肇. 四肢长骨创伤后骨髓炎诊断与治疗的难点及挑战. 中华创伤杂志, 2015, 31(4):289-292.
19. 祝勇刚, 张大伟, 赵广跃, 等. 抗生素骨水泥联合自体骨移植及环形外固定架修复骨髓炎后胫骨缺损. 中国组织工程研究, 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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