肌皮瓣联合骨水泥治疗Cierny-Mader Ⅲ~Ⅳ型骨髓炎的疗效  

Efficacy of myocutaneous flap combined with bone cement in the treatment of Cierny-Mader type Ⅲ~Ⅳ osteomyelitis

作　　者：王明智 郑钧水 陈薇薇 杨专 张义容 叶朝辉[1] 宋庆华 王扬剑[1] 魏鹏[1] WANG Mingzhi;ZHENG Junshui;CHEN Weiwei;YANG Zhuan;ZHANG Yirong;YE Zhaohui;SONG Qinghua;WANG Yangjian;WEI Peng(Department of Plastic Repair and Reconstruction Surgery,Ningbo First Hospital,Ningbo,Zhejiang Province 315000,China;School of Medicine,Ningbo University,Ningbo,Zhejiang Province 315000,China;Department of Hand and Foot Microsurgery,Guanghan Orthopedic Hospital of Sichuan Province,Guanghan,Sichuan Province 618300,China)

机构地区：[1]宁波市第一医院整形修复重建外科,浙江宁波315000 [2]宁波大学医学院,浙江宁波315000 [3]四川省广汉骨科医院手足显微外科,四川广汉618300

出　　处：《中华显微外科杂志》2021年第1期29-35,共7页Chinese Journal of Microsurgery

基　　金：浙江省医药卫生科技项目(2018248656);宁波市自然科学基金(2019A602323,2017A610183,2019C50046)。

摘　　要：目的探讨应用肌皮瓣联合负载抗生素聚甲基丙烯酸甲酯(PMMA)骨水泥来治疗Cierny-Mader Ⅲ~Ⅳ型骨髓炎的临床效果。方法2014年4月至2019年3月,对53例Cierny-Mader Ⅲ~Ⅳ型慢性骨髓炎患者,应用负载抗生素PMMA骨水泥联合肌皮瓣技术进行修复。其中男33例,女20例,年龄52.2±3.0(29~78)岁。53例骨髓炎病灶创面大小为2.0 cm×2.0 cm~14.0 cm×28.0 cm。皮瓣供区均直接缝合。术后3个月取出骨水泥23例,未取出骨水泥30例。术后观察皮瓣血运、创面渗液、供区并发症、X线复查有无新鲜骨破坏征象及皮瓣的色泽、质地、瘢痕等情况。门诊定期随访。结果49例创口一期愈合,4例创口延期愈合。术后发生血管危象6例,及时手术探查后缓解。术后随访0.6~3.0年,平均为18个月。53例肌皮瓣全部成活,色泽与受区相似,皮瓣平整,质地柔软,外形满意。随访期间X线复查无新鲜骨破坏征象,局部骨髓炎征象明显控制。皮瓣均未出现红肿、疼痛、局部破溃、渗液等炎症反应,无骨髓炎复发。所有供瓣区一期愈合。结论肌皮瓣联合负载抗生素PMMA骨水泥治疗Cierny-Mader Ⅲ~Ⅳ型骨髓炎,抗感染效果好,疗效满意,术后并发症少,复发率低,值得临床推广应用。Objective To investigate the clinical effect of myocutaneous flap combined with antibiotic-loaded polymethylmethacrylate(PMMA)cement in the treatment of Cierny-Mader type Ⅲ~Ⅳ osteomyelitis.Methods From April,2014 to March,2019,53 patients with Cierny-Mader type Ⅲ~Ⅳ chronic osteomyelitis were treated with myocutaneous flap combined with antibiotic-loaded PMMA cement.There were 33 males and 20 females,with an average age of(52.2±3.0)(29-78)years old.The area of the wound ranged from 2.0 cm×2.0 cm to 14.0 cm×28.0 cm.All flaps were closed directly.There were 23 patients who were removed the cement at 3 months after surgery,and the other 30 were not.After the surgery,the blood supply of the flap,the effusion of the wound,the complications of the donor area,signs of fresh bone destruction on X-ray and the color,the texture and scar of the flap were observed in the follow-up at the clinic.Results Forty-nine cases healed in one stage,and 4 had delayed healing.Postoperative vascular crisis occurred in 6 cases and releasesd by prompt surgical exploration.The patients were followed-up for 0.6-3.0 years,with an average of 18 months.All 53 myocutaneous flaps completely survived ultimately.The color of flaps was similar to the recipient areas,and the flaps were smooth and soft and satisfactory in appearance.During the follow-up period,X-ray examination showed no sign of fresh bone destruction.Osteomyelitis was significantly controlled.There was no inflammation reaction such as swelling,pain,ulceration and effusion of the flaps,and there was no recurrence of osteomyelitis.All donor areas healed primarily.Conclusion Myocutaneous flap combined with antibiotic-loaded PMMA cement has achieved good anti-infection effects in satisfactory results,less postoperative complications and low recurrence rate in the treatment of Cierny-Mader type Ⅲ~Ⅳ osteomyelitis.Application and promotion of such technique would deliver good benefits.

关 键 词：骨髓炎 肌皮瓣 骨水泥 皮瓣血运 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]