封闭式负压引流技术联合开放植骨治疗胫骨创伤性骨髓炎  

TREATMENT OF TIBIAL TRAUMATIC OSTEOMYELITIS WITH VACUUM SEALING DRAINAGE COMBINED WITH OPEN BONE GRAFT

作　　者：杜全红[1] 丛海波[2] 史永安[1] 姜辉[1] 隋海明[1] 

机构地区：[1]文登整骨医院骨手显微外科,山东威海264400 [2]威海市文登中心医院骨科

出　　处：《中国修复重建外科杂志》2014年第5期562-565,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用封闭式负压引流技术(vacuum sealing drainage,VSD)联合开放植骨治疗胫骨创伤性骨髓炎的临床疗效。方法 2007年6月-2012年12月,收治胫骨创伤性骨髓炎患者23例。男15例,女8例;年龄22~48岁,平均32.5岁。受伤至该次入院时间7~18个月,平均8.6个月。15例伴局部贴骨瘢痕,范围为8 cm×4 cm^15 cm×8 cm。CT多平面重建检查示,11例为节段性骨硬化,长度为1.5~3.8 cm,平均2.6 cm;12例为部分骨硬化,范围为骨周径的1/3~2/3。在病灶彻底清除基础上行VSD控制感染,然后采用VSD联合开放植骨修复骨缺损,待创面有新鲜肉芽组织后根据创面情况选择游离植皮或局部皮瓣移位修复。结果术后2例出现外固定架针道感染,给予抗生素治疗后感染控制;修复术后创面均Ⅰ期愈合。23例均获随访,随访时间10~18个月,平均13.5个月。11例节段性骨硬化患者感染控制治疗时间为7~14 d,平均8.8 d;骨愈合时间32~40周,平均34.4周;VSD治疗3~6次,平均4.5次。12例部分骨硬化患者感染控制治疗时间为7~12 d,平均8.3 d;骨愈合时间24~31周,平均27.3周;采用VSD治疗3~5次,平均3.6次。1例于术后3个月感染复发,患者放弃治疗;其余患者随访期间无感染复发。结论 VSD联合开放植骨是一种治疗胫骨创伤性骨髓炎的有效方法。Objective To explore the effectiveness of vacuum sealing drainage （VSD） combined with open bone graft for tibial traumatic osteomyelitis. Methods Between June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years （range, 22-48 years）. The time from injury to admission was 7-18 months （mean, 8.6 months）. There was local bone scarring in 15 cases, the size ranged from 8 cm × 4 cm to 15 cm × 8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm （mean, 2.6 cm）; 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer. Results Nail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months （mean, 13.5 months）. In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days （mean, 8.8 days）; the bone healing time was 32-40 weeks （mean, 34.4 weeks）; and the frequency of VSD was 3-6 times （mean, 4.5 times）. In 12 cases of partial bone sclerosis, the infection control time was 7-12 days （mean, 8.3 days）; the bone healing time was 24-31 weeks （mean, 27.3 weeks）; and the frequency of VSD was 3-5 times （mean, 3.6 times）. Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients. Conclusion The VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.

关 键 词：创伤性骨髓炎 开放植骨 封闭式负压引流技术 

分 类 号：R687.3[医药卫生—骨科学]