CAJ | 학술논문

目的探讨颗粒状松质骨移植治疗感染性骨不连伴大段骨缺损的效果.方法对19例(20个部位)感染性骨不连伴大段骨缺损患者进行清创、外固定、颗粒状松质骨移植方法治疗,其中自体骨移植14例(15个部位),异体骨移植5例.结果平均随访32.7个月(20～56个月).5例异体骨移植患者均无感染复发,其中3例获得骨愈合,外固定指数是(2.22±0.84)个月/cm;2例发生骨不连,再次手术取自体松质骨植骨获得骨愈合.14例(15个部位)自体骨移植患者,2例(2个部位,13.3%)感染复发导致植入骨吸收骨不连,接受再次清创自体骨移植获得骨连接、感染消灭;12例(13个部位,86.7%)骨愈合患者,外固定指数是(1.96±0.74)个月/cm.共3例(4个部位)发生再骨折,分别接受石膏固定、外固定支架及内固定获得骨愈合.结论感染性骨不连伴大段骨缺损采用自体颗粒状松质骨移植是合适的;异体骨移植骨不连发生率高、外固定时间长,应慎用.
목적 탐토과립상송질골이식치료감염성골불련반대단골결손적효과.방법 대19례(20개부위)감염성골불련반대단골결손환자진행청창、외고정、과립상송질골이식방법 치료,기중자체골이식14례(15개부위),이체골이식5례.결과 평균수방32.7개월(20～56개월).5례이체골이식환자균무감염복발,기중3례획득골유합,외고정지수시(2.22±0.84)개월/cm;2례발생골불련,재차수술취자체송질골식골획득골유합.14례(15개부위)자체골이식환자,2례(2개부위,13.3%)감염복발도치식입골흡수골불련,접수재차청창자체골이식획득골련접、감염소멸;12례(13개부위,86.7%)골유합환자,외고정지수시(1.96±0.74)개월/cm.공3례(4개부위)발생재골절,분별접수석고고정、외고정지가급내고정획득골유합.결론감염성골불련반대단골결손채용자체과립상송질골이식시합괄적;이체골이식골불련발생솔고、외고정시간장,응신용.
Objective To investigate the curative effect of managing infected nonunion with large skeletal defects utilizing debridement and granulated cancellous bone grafting. Methods Nineteen patients (20 sites)of infected nonunion with large skeletal defects in tibiae (n = 18) or ulna/radii (n =2) , 18 males and 1 female aged 31.3 (8-51), were treated with debridement,external fixation, and granulated cancellous bone grafting,14 patients (15 sites) by cancellous bone autografting and 5 patients (5 sites) by cancellous bone allografting. Follow-up was conducted for 32. 7 (20 - 56) months. Results Out of the 5 patients receiving allogra-fting, 3 gained bone union with an external fixator index of ( 2. 22 ± 0. 84 ) months/cm, 2 developed nonunion and subsequently gained union after receiving cancellous bone autografting, and no infection recurrence all of the 5 patients were found. Out of the 14 patients (15 sites) undergoing autografting, 2 patients (2 sites, 13. 3% )developed nonunion due to recurrent infection resulting in absorption of autograft, subsequently received debridement and autograftiug once again, and gained bone union and infection eradication; 12 patients ( 13 sites, 86.7% ) gained bone union with an external fixator index: of (1.96 ± 0. 74) months/cm. Re-fracture occurred in 3 patients (4 sites) and was cured by using cast immobilization (1 case), external fixator (1 case), or internal fixation (1 case). Conclusion Granulated cancellous bone autografting is a suitable method for managing infected nonunion with large skeletal defects. And cancellous bone allografting has a higher incidence of re-nonunion and longer time for using external fixator.