两种胸大肌肌瓣移植法治疗胸骨骨髓炎  

The effect of two means with pectoralis muscle flap on deep sternal wound infection

作　　者：高智强[1] 刘新宾 鲍黎明 高扬[1] 赵忠[1] 王盛宇[2] GAO Zhi-qiang;LIU Xin-bin;BAO Li-ming;GAO Yang;ZHAO Zhong;WANG Sheng-yu(Departmem of Cardiac Surgery,Aerospace Central Hospital,Beijing 100059,China;Departmem of Cardiac Surgery,Beijing Anzhen Hospital CapitalMedical University,Beijing 100029,China)

机构地区：[1]航天中心医院心脏血管外科,北京市100059 [2]首都医科大学附属北京安贞医院心脏外科

出　　处：《中国心血管病研究》2020年第7期639-642,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨两种胸大肌移位方法治疗胸骨骨髓炎的效果.方法2014年7月至2018年7月我院收治心脏外科术后并发纵隔感染患者115例,分别实施改良内侧胸大肌肌瓣对接填塞缝合方法(内侧肌瓣对接法)60例和外侧胸大肌肌瓣并翻转填塞缝合方法(外侧肌瓣翻转法)55例,观察两种方法在游离肌瓣面积、手术时间、术中出血量、术后引流量、术后引流管留置时间、住院时间、拆线时间、住院费用及并发症方面的差异.结果内侧肌瓣对接法手术时间(P=0.018)、术中出血量(P=0.001)、术后引流量(P=0.020)、术后引流管留置时间(P=0.001)、术后住院时间(P=0.006)、拆线时间(P=0.020)明显少于外侧肌瓣翻转法,差异有统计学意义;在并发症方面皮下血肿(P=0.020),内侧肌瓣对接法少于外侧肌瓣翻转法,差异有统计学意义;而在年龄、性别、纵隔感染病史长短、感染严重程度、原发病手术类型及致病菌的一般资料比较,差异无统计学意义.结论改良内侧胸大肌肌瓣对接填塞缝合方法(内侧肌瓣对接法)创伤小、住院时间少、再次手术发生率低、并发症少于外侧胸大肌肌瓣并翻转填塞缝合方法(外侧肌瓣翻转法),是治疗胸骨骨髓炎值得推荐的手术方法.ObjectiveTo investigate the effect of two means with pectoralis muscle flap on deep sternal wound infection.MethodsBetween July 2014 and July 2018,115 patients undergoing cardiac surgery were identified with deep sternal wound infection(DSWI).60 patients with DSWI were stabilized with intercalation of pectoralis major muscle flap and 55 patients treated with reverse lateral pectoralis major muscle flap.Results Patients treated with intercalation of pectoralis major muscle flap had a significantly shorter operation time(P=0.018),less quantity of bleeding during operation(P=0.001)and after operation(P=0.020),shorter drainage time(P=0.001),shorter hospitalization(P=0.006),shorter taking out stitches time(P=0.020)and fewer Subcutancous haematomas.However,there were no statistically significant differences in age,sex,history of mediastinal infection,severity of infection,types of primary surgery and pathogens.Conclusion The intercalation of pectoralis major muscle flap has less trauma,shorter hospitalization,fewer complications and the treatment effect of sternum osteomyelitis is bettcr than reverse latcral pectoralis major muscle flap.

关 键 词：胸骨感染 胸骨骨髓炎 外科治疗 

分 类 号：R654.2[医药卫生—外科学]