创面负压治疗联合背阔肌肌瓣逆行翻转技术在治疗脊柱内固定术后深部感染中的应用  

Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap for postoperative deep infection after spinal instrumentation

作　　者：甘良雨 谢昆[1] 温冰[1] 

机构地区：[1]北京大学第一医院整形烧伤科,100034

出　　处：《中华创伤骨科杂志》2018年第2期147-151,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探索在保留移植物的基础上治疗脊柱内固定术后深部感染的新方法。方法回顾性分析2015年1月至2016年5月期间使用创面负压治疗联合背阔肌肌瓣逆行翻转技术治疗的4例脊柱内固定术后延迟深部感染患者资料，男2例，女2例；年龄62～75岁，平均69．2岁。通过美兰引导下进行严格清创、创面负压吸引治疗，待患者创面细菌培养阴性，相关炎性反应指标降至正常范围后，行背阔肌逆行翻转填塞创面，并继续于切口外行创面负压治疗。结果4例患者均在术后1周时拆除创面负压装置，切口愈合良好，术后2周内完全愈合，移植物得以保留。复查血常规、C反应蛋白、红细胞沉降率、降钙素原均基本正常后出院。4例随访时间均超过1年，均未出现感染复发、腰椎内固定物松动等不良结果。结论使用创面负压治疗联合背阔肌肌瓣逆行翻转技术在保留移植物的基础上治疗脊柱术后深部感染方面不失为一种新的尝试，或能提高移植物的保留率、加速创面愈合速度及提高感染治愈率。Objective To explore a potentially effective treatment of postoperative deep infection after spinal instrumentation without removal of implants. Methods A total of 4 patients with postoperative deep infection after spinal instrumentation were treated at our hospital between January 2015 and May 2016. They were 2 men and 2 women, aged from 62 to 75 years （mean, 69.2 years） . They were treated with ag- gressive surgical debridement under the guidance of methylene blue and negative pressure wound therapy. Reversed latissimus dorsi muscle flap was used to obturate the wound when the bacterial culture of the wound was negative and the relevant inflammatory indicators returned to normal. Negative pressure treatment con- tinued over the closed incision. Results The devices for negative pressure wound therapy were removed in the 4 patients one week after surgery. All the wounds were healed well by first intention 2 weeks after surgery without removal of their implants. The patients were discharged after their examinations for blood routine, CRP, ESR and PCT turned to be normal. Follow-ups for more than one year revealed no re-infection, implants loosening or other adverse effects. Conclusions Negative pressure wound therapy combined with reversed latissimus dorsi muscle flap is a new attempt to treat postoperative deep infection after spinal instru- mentation without implant removal. It may increase the rate of implants reserved, accelerate wound healing and raise the curative rate of deep infection.

关 键 词：脊柱 内固定器 负压伤口疗法 背阔肌肌瓣 移植物感染 

分 类 号：R687.3[医药卫生—骨科学]