万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面中的应用  

Application of vancomycin cement combined with propeller flap in the repair of infective calcaneal exposed wound

作　　者：段家章 何晓清[2] 徐永清[2] 王腾[2] 冯凡哲[2] 余开富[1] 杨曦[2] 李国栋[1] 

机构地区：[1]第三军医大学研究生管理大队,400038 [2]成都军区昆明总医院全军创伤骨科研究所,650032

出　　处：《中国矫形外科杂志》2016年第22期2035-2039,共5页Orthopedic Journal of China

基　　金：全军后勤科研计划面上项目(编号:CCD14J003);全军后勤科研计划重大专项(编号:AWS14C003)

摘　　要：[目的]探讨万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面及预防跟骨骨髓炎中的临床应用价值。[方法]2012年1月~2015年3月,应用万古霉素骨水泥联合胫后动脉穿支或腓动脉穿支螺旋桨皮瓣修复感染并跟骨骨折骨外露创面13例。其中10例伤口分泌物细菌培养为阳性,创面缺损范围5.0 cm×3.5 cm^8.5cm×7.0 cm。术前用手持普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,清除游离及坏死的骨质;按术前设计切取皮瓣,皮瓣旋转修复创面;在皮瓣下方跟骨缺损或感染严重的区域放置万古霉素骨水泥条1~2根,术后1个月拔出。皮瓣切取范围14.5 cm×4.0 cm^27.0 cm×7.5 cm,8例供区直接缝合,5例供区植皮修复。其中3例因跟骨缺损较多,术后二期行取髂骨植骨术。[结果]术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,创面及供区切口Ⅰ期愈合。患者均获随访,随访时间12~23个月,平均17个月。随访中均未发现创面处感染复发及窦道形成,X线片未见骨髓炎病灶形成。所有皮瓣外形良好。末次随访时根据美国足踝外科协会(AOFAS)评分评价足部功能,足部功能总优良率为76.9%。[结论]万古霉素骨水泥联合螺旋桨皮瓣是修复感染性跟骨外露创面及防治跟骨骨髓炎的有效方法。[ Objective]To investigate the clinical application value of vancomycin cement combined with propeller flap in the repair of the infective calcaneus exposure wound and in the prevention of calcaneal osteomyelitis. [ Method ] From January 2012 to March 2015,13 cases with infection and calcaneal fracture bone exposed wounds were treated by vancomycin cement combined with posterior tibial artery or peroneal artery perforator propeller flap. Among all the cases,the wound secretion bacte- rial culture was positive in 10 cases, and the defect area ranged from 5.0 em - 3.5 cm to 8.5 cm x 7.0 cm. Hand - held Doppler ultrasound was used to locate the perforators and complete propeller flap design before operation. Thorough debridement during the operation was carried out in order to remove free and necrosis of bone. Preoperative design guided the flap harvest and flap rotation repaired the wound. In the bottom flap calcaneus defect or serious infection area 1 - 2 vancomycin cement bars was placed,and pulled out after 1 month. The size of flaps varied from 14.5 cm -4.0 cm - 27.0 cm - 7.5 cm. The donor site in 8 cases was directly sutured, and in 5 cases was repaired by skin graft. Among them,3 cases due to the large defect of the heel was performed iliac bone grafting in the second intention of post- operation. [ Result] During the operation,the flaps were success- fully harvested and the wounds were repaired. All flaps survived smoothly. The wounds and donor sites were healed by first inten-tion. All cases were followed up from 12 months to 23 months （mean, 17 months）. No wound infection recurrence and no sinus tract formation was found in the follow - up, no osteomy- elitis was found by the X - ray. All flaps had good shape. Foot function was scored by American Orthopaedic Foot and Ankle Society （AOFAS） in the last follow - up, and the excellent and good results rate of the foot function was 76.9%. [ Con- clusion] Vancomycin cement combined with propeller flap isan effective way in the repair of the infective cal

关 键 词：万古霉素 骨水泥 螺旋桨皮瓣 跟骨外露 创面修复 骨髓炎 

分 类 号：R687.3[医药卫生—骨科学]