41例胸骨骨髓炎的外科综合治疗  

Comprehensive treatment of forty-one patients with sternal osteomyelitis

作　　者：周业平[1] 田鹏[1] 于东宁[1] 王晓军[1] 杜伟力[1] 张国安[1] 

机构地区：[1]北京积水潭医院烧伤科,100035

出　　处：《中华损伤与修复杂志（电子版）》2010年第3期16-18,共3页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的总结分析胸骨劈开术后胸骨骨髓炎及纵隔感染的外科综合治疗方法,为提高临床疗效提供参考。方法回顾2005年9月至2010年5月因开胸手术至胸骨骨髓炎的41例患者的临床资料,经过术前各项准备,包括抗感染、心肺功能调理、营养支持等,根据伤情选择单纯清创、清创加负压,胸大肌肌瓣、腹直肌肌瓣、胸大肌腹直肌联合、胸大肌肌瓣翻转、大网膜轴行组织瓣,伤口一期或二期封闭。结果 41例患者中3例死亡,18例一期修复,14例二期封闭伤口,6例清创后换药加负压治疗直至伤口愈合。随访有2例手术半年后局部破溃,经简单清创后换药愈合,其余36例患者未见复发。结论开胸术后的胸骨骨髓炎患者全身情况复杂多变,术前准备极为重要,伤口的修复可以根据不同情况选择保守治疗或组织瓣修复,术后要跟踪随访,复发后及时处理。Objective To summarize the comprehensive treatment of sternal osteomyelitis.Methods Forty-one patients with sternal osteomyelitis were enrolled in this retrospective study,who received perioperative period nutrition support,antibiotics and cardiopulmonary function supports,and different therapy was selected to close the wound,including major pectoral muscle flap,rectus abdominis muscle flap,great omentum flap and negative pressure wound closure treatment.Results Among these forty-one patients,three died of cardiopulmonary function failure,eighteen closed wound with one operation,fourteen received second operation,six closed their wound simply by negative pressure and change dressing after debridement,the other patients received different kinds of flaps and closed their wound by first or second stage.Conclusion Comprehensive treatment of patients with sternal osteomyelitis including cardiopulmonary function supports and nutrition support is helpful for operation,and effective for the wound closure.

关 键 词：胸骨骨髓炎 皮瓣 负压吸引 

分 类 号：R681.2[医药卫生—骨科学]