扩大清创后Ⅰ期同种异体或混合骨移植治疗慢性骨髓炎

目的探讨采用同种异体或混合骨移植重建慢性骨髓炎清创术后骨缺损的可行性.方法 1999年2月-2002年4月,对26例慢性骨髓炎患者采用扩大清创后Ⅰ期同种异体(19例)或混合(7例)骨移植的方法进行治疗. 结果随访13～51个月,26例患者中,23例(88%)获得愈合,1例(4%)切口持续渗液14个月后愈合,2例(8%)感染复发. 结论在扩大清创的基础上,行Ⅰ期同种异体或混合骨移植治疗慢性骨髓炎可以获得较高的成功率,不应再视为禁忌证.     

尺桡骨慢性骨髓炎应用抗感染活性骨Ⅰ期植骨治疗的疗效评价

目的验证抗感染活性骨(ARBX)Ⅰ期植骨治疗尺桡骨慢性骨髓炎的疗效。方法对2001年11月～2007年9月ARBXⅠ期植骨并获得16个月以上系统随访的尺桡骨慢性骨髓炎8例(10处)进行疗效分析。结果随访时间16～63个月,平均31个月。8例10处ARBX植骨中除1例残留骨不连,其余7例(9处)骨髓炎完全治愈:感染彻底控制无复发,骨不连、骨缺损获得骨修复。结论 ARBX具有高效诱导成骨活性和强效抗感染能力,在病灶彻底清除的基础上,能Ⅰ期植骨有效治疗尺桡骨慢性骨髓炎。     

清创后Ⅰ期改良开放式松质骨移植治疗慢性骨髓炎

目的 缩短慢性骨髓炎的疗程，提高其治疗效果。方法 设计并采用清创后Ⅰ期改良开放式松质骨移植对39例患者进行治疗。结果 39例患者中，37例(95％)治疗成功，2例感染复发。结论 (1)清创后Ⅰ期植骨的疗效与Ⅱ期植骨相似。(2)改良开放植骨创面小、愈合时间短、不需要植皮或皮瓣移植，与Papineau方法相比优势显著。     

髓腔超扩Ⅰ期植骨封闭治疗全骨干骨髓炎

目的 探讨全骨干骨髓炎的治疗方法及效果。方法 对13例患者股骨（8例）或胫骨（5例）全骨干骨髓炎采用髓腔超扩Ⅰ期植骨封闭方法进行治疗。结果 12例治疗成功。1例失败。结论 髓腔超扩植骨封闭方法治疗全骨干骨髓炎是可行的，可以获得较高的成功率。     

开放植骨治疗跟骨骨折术后慢性跟骨骨髓炎

跟骨骨折采用切开复位内固定手术治疗，术后伤口感染甚至并发慢性跟骨骨髓炎已不少见，治疗非常困难。1996—2006年我科收治跟骨骨折术后慢性骨髓炎伴溃疡瘘管或皮肤缺损患者11例，采用病灶清除，Ⅰ期或Ⅱ期自体髂骨开放植骨的方法治疗，取得了满意效果。     

一期复合植骨、人工皮、负压引流治疗创伤性骨髓炎10例

2008年12月～2012年3月治疗创伤性骨髓炎10例,先彻底清除骨髓炎病灶及炎性肉芽组织、瘢痕组织;骨性病灶区内同时Ⅰ期植入含万古霉素硫酸钙颗粒和自体髂骨块的复合体,行负压封闭引流(VSD)。术后1～3周通过Ⅱ期缝合、植皮或随意皮瓣修复软组织创面。随访6个月～3年,骨髓炎均无复发。10例软组织创面均愈合。     

抗感染活性骨在成人创伤性骨髓炎治疗中的应用

目的 验证抗感染活性骨(anti-infective reconstituted bone xenograft,ARBX)Ⅰ期同步植骨治疗成人创伤性骨髓炎的疗效.方法 在获得解放军总后勤部卫生部军内临床试用研究许可的基础上,将ARBX用于临床Ⅰ期同步植骨治疗成人创伤性骨髓炎40例,对其中获得12个月以上系统随访的27例患者(ARBX植骨部位29处)进行总结分析研究.结果 随访时间12～63个月,平均26个月.27例患者(29处骨髓炎)有22例(24处)骨髓炎完全治愈:感染彻底控制无复发,骨不连、骨缺损获得骨修复;有2例骨髓炎治愈无复发,但残留骨不连;有3例骨髓炎未治愈或复发.本组29处创伤性骨髓炎有26处感染控制且无复发,其感染治愈率为89.7%;有24处既感染控制无复发又完成骨修复,其完全治愈率为82.8%.结论 ARBX具有高效诱导成骨活性和强效抗感染能力,是Ⅰ期植骨治疗成人创伤性骨髓炎的有效方法.     

Ⅰ期前路病灶清除、植骨内固定术治疗胸腰椎结核临床疗效分析

目的 探讨胸腰椎结核的最佳手术治疗方法。方法 对22例胸腰椎结核病人采用Ⅰ期前路病灶清除、植骨内固定。观察治疗效果。结果 20例甲级愈合，临床症状消失，2例术后3周出现窦道形成，5～8月后愈合。结论 Ⅰ期前路病灶清除、植骨、前路内固定治疗胸腰椎结核是安全可行的。     

中药治疗慢性骨髓炎72例疗效观察

慢性骨髓炎是骨科常见多发病，国内外对慢性骨髓炎的治疗方法曾有报导，但效果多数病例不十分理想，虽经多方努力复发病例仍不少见。近年来采用中药巴豆丸和毛白杨波治疗72例慢性骨髓炎，追终观察三年复发率明显降低，收到满意疗效，现报告如下。1临床资料和方法1．1临床资料72例慢性骨髓炎病人均为住院病人。其中男48例，女24例，平均年龄28岁。有瘘管51例，无瘘管21例，病程最长30年，最短10个月。疗程最长280天，最短21天，平均疗程48天。股骨32例、足腓骨32例，肱骨8例，其它骨9例。诊断依据：①局部红肿热病或畏寒发烧等急性骨髓炎病史…     

The bone marrow scan in experimental osteomyelitis

Osteomyelitis causes an inflammatory reaction within the bone marrow early in its course, suggesting that bone marrow imaging with Tc-sulfurcolloid could be used for early detection of the disease. To test this hypothesis, 11 rabbits were inoculated with Staphylococcus aureus, 7 adults in the bone marrow and 4 immature rabbits in the epiphyseal plate. Six rabbits developed osteomyelitis by radiographic and pathologic criteria. Each demonstrated a marked decrease in reticuloendothelial function in the area of osteomyelitis, 4–11 days before radiographic changes were noted. The bone marrow scan was normal in septic arthritis, which was present in some animals before osteomyelitis became evident. These findings suggest that the bone marrow scan is a potentially useful study in early detection of osteomyelitis.Supported by grant UFPHF GM 10548 NIH, Bethesda, Md.     

The penumbra sign in subacute osteomyelitis

The penumbra sign is a characteristic magnetic resonance (MR) feature of subacute osteomyelitis. It can be identified on unenhanced T1-weighted spin echo images as a discrete peripheral zone of marginally higher signal intensity than the central bony abscess cavity and the surrounding lower signal intensity of the reactive new bone and oedema.     

骨髓炎与恶性骨肿瘤软组织改变的影像比较

目的 探讨软组织影像改变对骨髓炎和恶性骨肿瘤的鉴别诊断价值。方法 通过回顾性分析。对57例骨髓炎和70例恶性骨肿瘤患者软组织异常CT和MRI征象进行界定、观察、记录和统计学比较。结果57例骨髓炎患者中，CT检查54例，MR检查14例。CT检查的54例中，软组织肿胀52例（Ⅰ度19例、Ⅱ度16例、Ⅲ度17例），脓肿样囊腔6例，软组织肿块5例，软组织内气体、脂液平面和窦道各1例。MR检查的14例骨髓炎中，软组织肿胀14例（Ⅰ度2例、Ⅱ度6例、Ⅲ度6例），脓肿样囊腔（扩散加权成像均呈明显高信号）3例，软组织肿块和脂液平面各1例。70例恶性骨肿瘤患者中，CT检查54例，MR检查49例。CT检查的54例中，软组织肿胀44例（Ⅰ度29例、Ⅱ度12例、Ⅲ度3例），软组织肿块49例，软组织肿块边缘残留骨壳或壳样钙化16例，软组织肿块内肿瘤骨或瘤软骨钙化25例。MR检查的49例恶性骨肿瘤中，软组织肿胀46例（Ⅰ度21例、Ⅱ度17例、Ⅲ度8例），软组织肿块43例。骨髓炎组和恶性骨肿瘤组CT图像显示的软组织肿胀程度（Uc=4．1066，P〈0．01）以及脓肿样囊腔（X^2=4．4118，P〈0．05）、肿块（X^2=71．7037，P〈0．01）、肿块边缘残留骨壳或壳样钙化（X^2=18．7826，P〈0．01）和肿块内肿瘤骨或瘤软骨钙化（X^2=32．5301，P〈0．01）出现比例差异具有统计学意义。MR图像所示的软组织肿胀程度（Uc=2．5997，P〈0．01）以及脓肿样囊腔（四格表确切概率P=0．0092）和肿块（X^2=29．8757，P〈0．01）出现比例差异亦有统计学意义。结论 软组织肿胀程度和软组织肿块对骨髓炎和恶性骨肿瘤鉴别具有一定价值。软组织肿块边缘残留骨壳或壳样钙化以及软组织肿块内肿瘤骨或瘤软骨钙化是恶性骨肿瘤的特异性征象。脓肿样囊腔、软组织内气体、脂液征和窦道是骨髓炎的可靠征象。     

Periostitis and osteomyelitis in chronic drug addicts

Periostitis and osteomyelitis can occur in drug addicts not only by hematogenous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss.     

MRI in chronic recurrent multifocal osteomyelitis

 Objective. To review our experience of chronic recurrent multifocal osteomyelitis (CRMO) and to assess the value of MRI in this rare disease, which mainly affects children and adolescents. Design and patients. Seventeen patients from our departments were reviewed. All underwent conventional radiography and MRI, and most had bone scintigraphy. All had undergone bone biopsy, with microbiological and histopathological examinations, to exclude infectious disease, tumours and tumour-like lesions. Results and conclusion. CRMO affects predominantly the tubular bones of the limbs, followed by the clavicle and the spine. Other locations are rare. Diagnosis is important in avoiding unnecessary diagnostic procedures and to initiate appropriate therapy, and is usually based on a characteristic course and the appearances on radiography. However, CRMO lesions of tubular bones and the spine exhibit quite characteristic MRI features which support the diagnosis, while the appearance of the early clavicular lesion is non-specific. At all sites of CRMO in the skeleton, MRI is valuable in assessing the extent and activity of the lesion. It may exclude pyogenic involvement of the bone and soft tissues and guide effective biopsy.