骨皮瓣移植加置管冲洗治疗慢性骨髓炎  

Osteocutaneous flap transplantation plus catheter irrigation for chronic osteomyelitis with dead bone and sinus infective tissue

作　　者：常正奇[1] 刘雪涛[1] 张成进[1] 李忠[1] 曲连军[1] 

机构地区：[1]89医院创伤骨科研究所二病区,山东潍坊261021

出　　处：《实用医药杂志》2008年第7期777-780,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的总结利用游离骨皮瓣进行移植+置管冲洗治疗下肢慢性骨髓炎后死骨及窦道的方法和疗效。方法2002-01￣2007-02对35例下肢创伤后慢性骨髓炎患者,采用术中彻底切除死骨,大范围切除窦道周围感染色素沉着皮肤或不健康组织,利用游离骨皮瓣覆盖创面+置管冲洗进行治疗,随访治疗效果并进行分析。结果本组35例,随访12～60个月,平均30个月。皮瓣全部成活,移植骨全部愈合,愈合时间3￣14个月,平均5个月,伤口Ⅰ期愈合30例,Ⅱ期愈合5例;冲洗管留置1～3个月,平均42d拔管,1例冲洗65d夹管后仍有分泌物排出,加用敏感抗生素冲洗15d后变清澈,顺利拔管。骨髓炎复发2例,经二次病灶清除愈合。结论切除死骨及窦道周围不健康组织,切取皮瓣、骨皮瓣、肌皮瓣、骨瓣,设计复合、组合或者联合等多种形式的骨皮瓣进行移植+置管冲洗进行治疗,是临床可行、可靠的治疗慢性骨髓炎方法。Objective To describe the method and clinical effect of all kinds of osteocutaneous flap grafting in the treatment for chronic osteomyelitis with bone-skin defect and infection. Method From January 2002 to February 2007,free composite and component or united osteocutaneous flap were carried out to treat 35 patients of this disease, and the foLlowed-up curative effect was analyzed. Result The 35 cases were followed up for 12-60 months, average 30 months. All of the flap survived,the wound unioned well at first stage in 30 cases and 5 cases were at second stage; All grafted bone united in 3- 14 months, average 5 months; After operation the wounds were irrigated 1-3 months （average 45 days）. There was one patient also had some impurity in the water after 65 days, but sensitive antibiotics were used the water became limpidity after 15 days. Osteomyelitls recurred in 2 cases, then got healed by nidus clearing. Conclusion Cut the dead bone and sinus infective tissue, then free composite or component or united osteocutaneous flap were chosed to treat chronic osteomyelitis with bone-skin defect and infection. This method is appropriate and effective.

关 键 词：骨皮瓣 显微外科技术 慢性骨髓炎 骨缺损 创面冲洗 

分 类 号：R681.2[医药卫生—骨科学]