Objective: To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection.
Methods: The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score.
Results: All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%.
Conclusion: Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.
目的: 探讨有限内固定联合铰链式外固定架治疗肘关节周围骨感染的临床疗效。.
方法: 回顾分析2018年5月—2021年5月收治的19例采用有限内固定联合铰链式外固定架治疗的肘关节周围骨感染患者临床资料。男15例，女4例；年龄28～61岁，平均44.6岁。肱骨远端骨折13例，尺骨近端骨折6例。19例均为骨折内固定术后感染，合并桡神经损伤2例。骨感染根据Cierny-Mader解剖分型标准：Ⅱ型11例，Ⅲ型6例，Ⅳ型2例。骨感染病程1～3年。一期病灶清创后骨缺损（3.04±0.28）cm，缺损区植入抗生素骨水泥，安装外固定架；3例行背阔肌皮瓣修复，2例行臂外侧筋膜皮瓣修复。6～8周感染控制后行骨缺损修复重建手术。术后观察创面愈合情况，并定期复查白细胞（white blood cell count，WBC）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reaction protein，CRP）、降钙素原（procalcitonin，PCT）等评估感染控制情况。术后定期摄患肢X线片观察缺损区骨愈合情况。末次随访时观察肘关节屈伸活动度及总活动度，与术前比较；并采用Mayo评分评价肘关节功能。.
结果: 患者均获随访，随访时间12～34个月，平均26.2个月。5例行皮瓣修复后创面均愈合。2例感染复发，经再次清创并更换抗生素骨水泥后得到有效控制，一期感染控制率为89.47%（17/19）。2例合并桡神经损伤者经术后康复锻炼，患肢肌力从术前Ⅲ级恢复至约Ⅳ级。所有患者随访期内未出现切口破溃、渗液、骨不连、感染复发及取骨区感染等并发症。骨愈合时间16～37周，平均24.2周。末次随访时WBC、ESR、CRP、PCT及肘关节屈曲、伸直活动度和总活动度均较术前显著改善，差异有统计学意义（ P<0.05）。根据Mayo肘关节评分标准评价，获优14例，良3例，可2例，优良率89.47%。.
结论: 有限内固定联合铰链式外固定架治疗肘关节周围骨感染，能有效控制感染，恢复患侧肘关节功能。.
Keywords: Limited internal fixation; hinged external fixator; peri-elbow bone infection.