心血管外科术后慢性胸骨骨髓炎伴窦道临床分析  

Clinical analysis of chronic sternal osteomyelitis with sinus tract after cardiovascular surgery

作　　者：郭宏伟[1] 孔维生[1] 赖轶权[1] 匡锋[1] 庄嘉伟 单忠责 

机构地区：[1]厦门大学附属第一医院心脏外科,361000

出　　处：《中华医学杂志》2018年第8期592-595,共4页National Medical Journal of China

摘　　要：目的分析总结心脏大血管术后慢性胸骨骨髓炎伴窦道形成的原因，并探讨其诊断、治疗与预防措施。方法回顾性分析。2000年1月至2016年1月厦门大学附属第一医院心脏外科收治的心脏大血管手术后慢性胸骨骨髓炎伴窦道形成患者，经窦道造影及胸骨CT三维重建明确诊断后，采取以手术治疗为主的综合治疗方法，彻底清除窦道壁肉芽组织、坏死骨质及异物，组织缺损较大者以腹直肌或胸大肌肌皮瓣转移填充缺损，必要时行中厚皮片移植。术后继续给予切口换药、抗感染、营养支持、控制血糖等治疗。结果共53例患者，1例术前因窦道所致升主动脉假性动脉瘤破裂死亡，余52例均接受手术治疗。所有手术患者无围手术期死亡，其中45例胸部伤口Ⅰ期愈合，7例Ⅱ期愈合。Ⅱ期愈合患者中5例经再次清创缝合后痊愈，2例再次接受清创及肌皮瓣移植后治愈。有12例患者因创面较大接受中厚皮片植皮手术，效果良好。患者术后至伤口完全愈合时间3～12周。术后随访时间5～18个月，所有患者胸部切口均愈合良好，未再出现局部渗液、红肿、疼痛等，生活质量明显改善。结论慢性胸骨窦道患者明确诊断后应在积极术前准备的前提下尽早手术治疗。以胸骨窦道清创术、肌皮瓣转移填充术为主的综合治疗方法治疗慢性胸骨窦道安全、有效。ObjectiveTo explore the diagnosis, therapy and prevention method of chronic sternal osteomyelitis with sinus tract after cardiovascular surgery.MethodsA total of 53 patients with chronic sternal sinus tract after cardiovascular surgery between January 2000 and January 2016. After definite diagnosis by contrast fistulography and CT scanning, all the patients received combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation if necessary.ResultsOne patient died of false aneurysm due to the sternal sinus tract infection, there were no peri-operative death for all the left 52 patients. Forty-five patients had primary healing and 7 patients had secondary healing. All the patients became total recovery within 3-12 weeks after operation and maintained well during the 5-18 months′ follow-up.ConclusionsFor the patients with chronic sternal osteomyelitis, operative therapy should be performed as soon as possible once the diagnosis is confirmed. Combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation is confirmed to be effective and secure.

关 键 词：骨髓炎 窦道 胸骨 心血管外科手术 

分 类 号：R654[医药卫生—外科学]