Background. Longbone infected bone defect remains a great challenge due to multiple surgeries, long-term treatment duration, and uncertain prognosis. Treatment principles include eradication/debridement, stabilization, and antibiotic administration. An antibiotic cement-coated nail has shown great prospects due to both local antibiotic elution and stabilization of bone defects. However, the current fabrication technique remains to be improved. Methods. For the first time, we described a new method for custom-made cement-coated nail fabrication based on a 3D printing technique. A retrospective study of 19 consecutive patients with long bone infected bone defects from one medical center was conducted who met the inclusion and exclusion criteria from November 2016 to May 2020. The treatment involved thorough debridement, custom-made antibiotic cement-coated nail filling, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Clinical and radiographic examinations (X-ray and CT scans) were used to evaluate bony union. Clinical and laboratory examinations were used to evaluate the infection control. The SF-36 score was used to evaluate patients’ quality of life pre- and postoperatively. Results. The mean follow-up was 98.8 weeks (ranging from 40 to 192). All cases achieved infection control, 3 cases achieved bone healing after one-stage operation, and 12 cases achieved bone healing after a two-stage bone graft procedure. At the last follow-up, none of the 19 patients had infection recurrence or 1 case had failure of the protective plate. The pre- and postoperative SF-36 score showed that there were statistical differences in all the 9 aspects. Conclusions. The precise custom-made antibiotic cement-coated intramedullary nail through the 3D printing technique used in this study is an effective strategy for the treatment of infected bone defects of long bone. This technique may help to increase the infection control rate and promote bone healing.

中文翻译：

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用于治疗感染性骨缺损的定制抗生素水泥涂层指甲

背景。由于多次手术、长期治疗时间和不确定的预后，长骨感染性骨缺损仍然是一个巨大的挑战。治疗原则包括根除/清创、稳定和抗生素给药。由于局部抗生素洗脱和骨缺损的稳定，抗生素水泥涂层指甲显示出巨大的前景。然而，目前的制造技术仍有待改进。方法. 我们首次描述了一种基于 3D 打印技术的定制水泥涂层指甲制造新方法。对 2016 年 11 月至 2020 年 5 月来自一家医疗中心的 19 名符合纳入和排除标准的连续 19 例长骨感染性骨缺损患者进行回顾性研究。治疗包括彻底清创、定制抗生素水泥涂层指甲填充和由多学科团队指导的培养特异性全身抗生素治疗。临床和放射学检查（X 射线和 CT 扫描）用于评估骨愈合。临床和实验室检查用于评估感染控制。SF-36评分用于评估患者术前术后的生活质量。结果. 平均随访时间为 98.8 周（范围从 40 到 192）。全部病例感染控制，3例一期术后骨愈合，12例二期植骨术后骨愈合。末次随访时，19例患者均无感染复发或1例保护板失效。术前术后SF-36评分显示9个方面均有统计学差异。结论。通过本研究中使用的3D打印技术精确定制的抗生素骨水泥涂层髓内钉是治疗长骨感染性骨缺损的有效策略。这种技术可能有助于提高感染控制率并促进骨愈合。