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1、外固定支架骨搬移治疗股肯干严重慢性骨髓炎38例分析【摘要】目的探讨股骨干骨折术后慢性感染的细菌学特点、治疗中的困难及治疗策略。方法对38例股骨干骨折术后慢性感染的临床资料进行冋顾性分析。结果术前细菌学明确诊断32例，其中金黄色葡萄球菌18例、溶血性链球菌6例、具他细菌8例。术中取标本，细菌培养38例均为阳性。38例中32例得到了随访，随访时间平均16个月，所有骨折全部得到愈合，愈合吋间为4〜10个月，平均6.6个月。结论(1)耐药金黄色葡萄球菌是股骨干骨折术后慢性感染的最常见病原菌，其次为溶血性链球菌和铜绿色假单胞菌;(2)股
2、骨干骨折术后慢性感染手术治疗难度大，没有手术经验的医师尽最不要尝试；(3)慢性骨感染采用I期或II期清创、骨搬移应根据患者具体情况决定，清创应尽最彻底、去除死骨、消灭死腔以降低感染复发率；(4)抗生素骨水泥在骨感染的应用用■以提高疗效；(5)术后康复对功能恢复十分重要。【关键词】股骨干骨折；感染；外固定；骨髓炎Analysisoftreatmentwithexternalfixationandbonetransportin38casesofseriouschronicosteomyelitisoffemoralboneYUHo
3、ng,XUNTeng,ZHAOYufeng,etal.(Dep^irtmentofOrthopedics,The404thHospitalofPLA,Weihai264200,China)Abstract:ObjectiveToexplorethebacteriologicalcharacteristics,thedifficultyintreatmentandtherapeuticstrategyofchronicinfectionafterfemoralshaftfracturesurgery.MethodsAnalyzi
4、ngretrospectively38caseswithchronicinfectionafterfemoralshaftfracturesurgery.ResultsBeforeoperation,32infectionswereconfinnedbybacteriologicalexamination,with18casesofstaphylococcusaureusinfection^casesofstreptococcushemolyticusinfectionand8casesofotherkindsofbacter
5、iainfection.All38caseswereconfirmedofinfectionafterbacterialculture.Totally32caseswerefollowedup,withanaveragefollowuptimeof16months.Atthefinalevaluation,allbonefracturehealed,withanaveragehealtimeof6.6months(range,4to10months).Conclusion(l)Drugresistantstaphylococc
6、usaureusisthecommonestpathogenicbacteria.followedbystreptococcushemolyticusandpseudomonasaeruginosa.(2)Secondaryoperationonchronicinfectionafterfemoralshaftsurgeryisverydifficult,soinexperiencedsurgeonisnotencouragedtoperformsuchoperation.(3)Debridementorbonetranspo
7、rtshouldbedoneinsuchcasesaccordingtotheneed,andwhendebridementisperformed,itshouldbedoneascompletelyaspossible.(4)Theuseofantibioticsembeddedbonecementcouldincreasethetherapeuticeffect.(5)Rehabilitationafteroperationisimportantforfunctionalrecovery.Keywords:temorals
8、haft;infection;externalfixation;osteomyelitis股骨干的创伤性骨髄炎多山严重创伤或治疗不当所致。多次手术失败、反复大剂嵐应用抗生素、局部大片软纽.织瘢痕、肢体短缩及骨缺损等因素，使治疗非常棘手，疗效不佳［1］。这是对外科治疗提出了新的
