The Application Of New-type Anti-infective Active Bone In The Treatment Of Open Fractures And Osteomyelitis

Due to accidents arising from rapidly developing transportation and industry, frequent natural calamities and local wars, and increasing high energy injuries, the cases of open fracture of limbs become more frequent. Improper treatment may lead to infected bone diseases, such as bone & soft tissue infection, infected nonunion of bone, and osteomyelitis. How to treat open fracture effectively and prevent further infection is a tough problem in the field of orthopedics. To this end, our institute developed new anti-infection living bones, a new anti-infection bone grafting material. It uses recombined bone xenograft as the matrix, incorporates certain amount of gentamicin, and then is coated with gelatin and polycaprolactone (PCL), thus forming an implanted antibiotic slow release complex. Among other things, its major actions include: 1. Release antibiotic slowly at implanted part for the purpose of anti-infection; 2. Base on inactivated cancellous bone and bBMP in the matrix, exert the functions of bone conduction and bone induction to repair bone defects.The subject is intended to investigate the clinical application of the new anti-infection living bones and to study on its clinical efficacy of new in terms of prevention against & treatment for infection and repair of bone defects. The approach of retrospective study is adopted herein. The cases about the treatment for open fracture and osteomyelitis by implanting new anti-infection living bone in the year were collected and a data base was established. Follow up forms was designed with delicacy. We are informed of recovery condition of patients by means of correspondences, telephone or in the clinic. In the end, all data are summarized for an analysis and conclusions are arrived at.The results are listed as below: 1. 21 cases of open fracture were treated by implanting new anti-infection living bones. Delayed union of bone occurred on one patient. One nonunion of bone occurred on another patient, and upon surgery, the bone healed. Other patients of fracture saw primary union. No infection occurs for all of them. The time of bone union is 2-7 months for pure transverse fracture or oblique fracture, and 4-10 months for comminuted fracture. 2. 12 children with osteomyelitis were treated by implanting new anti-infection living bones. For all patients, the focuses of disease are cleared. The surgery of NAAB synchronized bone grafting was conducted. Follow-up visit of these patients were paid 12 months to 79 months after surgery. On average, follow up visit occurred 35 months later. 9 out of 12 patients are cured and definite bone repair is realized at diseased parts (residue bone cavity, nonunion of bone, bone defect after clearing of focus). For one patient, infection was not well controlled following NAAB synchronized primary bone grafting surgery; ten days later, clearing of focus was carried out; the osteomyelitis was cured then . For another patient, the osteomyelitis was brought under control following NAAB synchronized primary bone grafting surgery; the disease relapsed 16 months later; the osteomyelitis was cured after another NAAB bone drafting surgery; there wasn't relapse of osteomyelitis in 30 months of follow up visit. Nonunion of bone occurred for one patient after shortening reposition, NAAB bone drafting, fixation with steel plate and follow up visit. 3. 27 patients of traumatic osteomyelitis were removed from original fixation, their focuses of disease were cleared, NAAB implanting was conducted, and internal or external fixation surgery was conducted. Systematic follow-up visits were paid for these patients (29 diseased parts) 12 months to 63 months after the treatment. On average follow up visits were paid 26 months later. Among them, 26 infected parts were brought under control and the infection did not reoccur; definite bone repair was realized at diseased parts (residue bone cavity, nonunion of bone, bone defect after clearing of focus) . The cure rate is 82.8%, which is rather higher than that of traditional treatment (40%-67%). In two cases, the osteomyelitis was cured and did not relapse, but there was remained bone nonunion; when another fixation means is taken and bone grafting surgery was conducted, the bone healed. Three of them were not cured or there were a relapse; however, they were cured after respectively one, two and two of clearing of focus and dripping & drainage, they were cured.Conclusion: When the new anti-infection living bone is implanted fracture site of open fracture that is completely debrided, the living bone can repair bone defects, and prevent infection following surgery; In treating of osteomyelitis, it produces good clinical effect for children with osteomyelitis and patients of traumatic osteomyelitis, its effective percentage is considerably higher than that of traditional approaches.