吻合血管的骨瓣移植治疗Cierny-MaderⅢ、Ⅳ型胫骨骨髓炎  

Vascularized bone graft for tibial osteomyelitis of Cierny-Mader type Ⅲ or Ⅳ

作　　者：任义军[1] 严立 胡锐[1] 易新成[1] 丁凡[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院骨修复重建科,武汉430033

出　　处：《中华创伤骨科杂志》2015年第6期477-480,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨吻合血管的骨瓣移植治疗Cierny-MaderⅢ、Ⅳ型胫骨骨髓炎的疗效. 方法 对2010年5月至2014年6月收治的28例胫骨骨髓炎患者资料进行回顾性分析,男21例,女7例;年龄16～61岁,平均42.1岁;均为创伤后所致骨感染,治疗周期18个月至12年;Cierny-Mader分型：ⅢA9例、ⅢB型6例,ⅣA型10例,ⅣB型3例.行病灶扩大切除后分别切取带血管腓骨移植7例,带血管腓骨骨皮瓣10例,带血管髂骨瓣移植11例修复胫骨骨缺损.结果 所有患者术后获12个月至4年（平均32.3个月）随访,骨皮瓣全部存活.3例患者窦道延迟愈合,1例再次窦道形成.根据Paley治疗感染性胫骨骨不连优良评分标准,骨性结果功能均为优良.根据Johner-Wruhs胫骨干骨折评价标准：优21例,良7例.结论 Cierny-MaderⅢ、Ⅳ型胫骨骨髓炎行病灶彻底清创后,应用吻合血管的骨瓣移植修复胫骨缺损可取得较好的临床疗效.Objective To report our experience of treating tibial osteomyelitis of Cierny-Mader type Ⅲ or Ⅳ using vascularized bone graft.Methods From May 2010 to June 2014,we treated 28 patients with tibial osteomyelitis which was caused by post-traumatic bone infection.They were 21 men and 7 women,aged from 16 to 61 years （average,42.1 years）.Their entire treatment lasted from 18 months to 12 years.According to Cierny-Mader classification,9 cases were type ⅢA,6 cases type ⅢB,10 cases type ⅣA,and 3 cases type Ⅳ B.After lesions were resected extensively,vascularized free fibula transplantation was performed in 7 cases,vascularized free fibula transplantation plus skin flap in 10 cases and vascularized free iliac bone transplantation in 11 cases to manage tibial bone defects.Results Their follow-up periods ranged from 12 to 48 months （mean,32.3 months）.All the osteocutaneous flaps survived.Delayed healing of sinus tract occurred in 3 patients and formation of sinus tract recurred in one.According to Paley criteria for management of infectious tibial nonunion,all cases achieved an excellent or good outcome in both bony and functional aspects.According to Johner-Wruhs criteria for tibial diaphyseal fracture,21 cases were rated as excellent and 7 as good.Conclusion For treatment of tibial osteomyelitis of Cierny-Mader type Ⅲ or Ⅳ,application of vascularized bone graft after extensive resection of the lesion can be effective.

关 键 词：胫骨 骨髓炎 显微外科 移植 骨 

分 类 号：R687.3[医药卫生—骨科学]