带血管蒂腓骨骨皮瓣移植联合负压封闭引流治疗胫骨长段骨缺失的临床应用  

Application of vascularized fibular flap combined with vacuum sealing drainage in the repair of long tibia defect

作　　者：周益[1] 谭金海[1] 

机构地区：[1]武汉大学中南医院显微骨科,430071

出　　处：《临床外科杂志》2017年第3期222-225,共4页Journal of Clinical Surgery

摘　　要：目的观察带血管蒂腓骨骨皮瓣移植联合负压封闭引流对胫骨慢性骨髓炎伴骨缺失患者的临床疗效。方法慢性胫骨骨髓炎患者24例,一期手术彻底清除病灶,切除长段死骨,二期行对侧带血管蒂腓骨瓣移植修复胫骨缺损,后用负压封闭引流技术覆盖创面。结果术后24例患者均获得随访,随访时间为13~50个月,平均32.3个月。22例患者4周内窦道愈合,愈合率91.7%,不愈合的2例患者二次窦道清除后愈合。24例行骨皮瓣移植患者皮瓣全部存活,存活率为100%。X线片示24例移植腓骨均愈合,愈合率为100%,愈合时间4~7个月,平均4.9个月。按Enneking评价系统对患者进行术后功能评分,平均26分,平均恢复了肢体功能的86.7%。结论对胫骨慢性骨髓炎的患者行腓骨骨皮瓣移植联合负压封闭引流进行修复,不仅修复了骨缺损,恢复了肢体的连续性,同时应用的负压封闭引流技术能有效的控制感染,缩短了疗程,恢复了患侧肢体的功能。Objective To analyze the effects of vascularized fibular flap combined with vacuum sealing drainage （VSD） in the repair of tibia defect. Methods Clinical data of 24 patients with chronic osteomyelitis of the tibia who accepted the operation of vascularized fibular flap combined with VSD were collected in the study. In the first operation, the lesions were completely debrided and the dead bone was removed, then the vascularized fibular was replaced from the other limb to repair the tibia defect. Later, vacuum assisted closure was applied to cover the wound. Results All patients enrolled in the study were followed up for 13 to 50 months, with an average of 32.3 months. The sinus of 22 cases healed in 4 weeks and the healing rate was 91.7%. The other two patients received additional debridement for the sinus and they also healed soon after that. All flaps survived and the survival rate was 100%. The X-ray showed that the transplanted fibula was healed in all cases, with a healing rate of 100%. The healing time ranged from 4 to 7 months, with an average of 4.9 months. Based on the Enneking scoring system, the patients achieved an average score of 26 points out of 30 points, and the recovery rate of limb function was evaluated as 86.7%. Conclusion For patients with chronic osteomyelitis of the tibia, vascularized fibular flap combined with VSD can not only effectively repair bone defect, but also restore the continuity of limbs. The application of VSD can effectively control infection, shorten treatment course, and restore limb function.

关 键 词：胫骨缺损 腓骨瓣 负压封闭引流 慢性骨髓炎 

分 类 号：R687.3[医药卫生—骨科学]