摘要
背景彻底的手术清创是下肢慢性创伤性骨髓炎的治疗基础,但手术后遗留无效腔的管理是慢性骨髓炎修复的难点和要点。目的探讨带蒂肌瓣转移术治疗下肢慢性创伤性骨髓炎的临床效果。方法对2014年1月-2018年1月北京积水潭医院烧伤整形科收治的35例下肢慢性创伤性骨髓炎患者进行回顾性分析。对患者的一般情况、慢性骨髓炎的分型、病原学结果、抗生素应用、肌瓣选择、治疗前后的红细胞沉降率及C反应蛋白、疗效进行分析。结果男性29例(82.86%),女性6例(17.14%),年龄21~54(32.45±9.30)岁,均接受邻近下肢创面带蒂肌瓣转移手术进行治疗,并同时一期修复创面。所有病例慢性感染均得到控制,创面一期愈合24例,经换药后二期愈合11例。依病情需要成功接受二期骨科内固定手术6例。随访1~2年,全部病例感染均成功治愈,无复发。结论带蒂肌瓣移植术应用于慢性骨髓炎的治疗可以有效填塞下肢骨缺损空腔,有效覆盖外露骨质,改善骨质血运,对慢性骨髓炎感染抗感染能力强,是下肢慢性骨髓炎治疗中无效腔管理的较好选择。
Background Thorough surgical debridement is the first step for the treatment of chronic traumatic osteomyelitis of lower limbs,and the management of dead space after debridement is the key point of the treatment of the infection.Objective To evaluate the efficacy of pedicled muscle flaps for the reconstruction of chronic traumatic osteomyelitis of lower extremities.Methods A retrospective review of 35 consecutive cases with chronic traumatic osteomyelitis of lower extremities who underwent reconstruction by local pedicled muscle flap operation in Beijing Jishuitan Hospital from January 2014 to January 2018 was conducted.All cases had undergone pedicled muscle flap operation and would repair.Data were retrospectively reviewed concerning characteristics of the patients,C-M classification of chronic osteomyelitis,etiological results,application of antibiotics,choice of muscle flap,ESR,CRP changers and the wound healing.Results Of the 35 cases,there were 29(82.86%)males and 6(17.14%)females,with average age of 32.45±9.30 years(ranging from 21-54 years).All muscle flaps were survived and the wound healed completely within 4 weeks,including 24 cases achieved primary healing,and 11 cases healed within 1 month after dressing change.Six patients underwent internal fixation within 1 year after operation.No infection relapses were found during the follow-up period of 1-2 years.Conclusion These results show that the local pedicled muscle flap can effectively fill the cavity of lower limb bone defect,cover the exposed bone,improve bone blood supply,and have a strong anti-infection ability against chronic osteomyelitis infection,which is a good choice for the dead space management of chronic osteomyelitis in lower extremity.
作者
赵筱卓
沈余明
ZHAO Xiaozhuo;SHEN Yuming(Department of Burn and Plastic,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《解放军医学院学报》
CAS
北大核心
2022年第3期318-322,327,共6页
Academic Journal of Chinese PLA Medical School
关键词
慢性骨髓炎
无效腔
骨缺损
带蒂肌瓣
创面修复
chronic osteomyelitis
dead space
bone defect
local pedicle muscle flap
wound repair
