腓肠肌肌瓣联合载抗生素硫酸钙治疗老年胫骨平台骨折术后感染伴钢板外露  

Gastrocnemius muscle flap combined with antibiotics loaded calcium sulfate in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients

作　　者：林炳远[1] 黄凯[1] 刘亦杨[1] 任海勇 郭峭峰[1] 马苟平[1] 张春[1] LIN Bingyuan;HUANG Kai;LIU Yiyang;REN Haiyong;GUO Qiaofeng;MA Gouping;ZHANG Chun(Department of Orthopedics,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院骨科,杭州310012

出　　处：《中华显微外科杂志》2021年第3期272-275,共4页Chinese Journal of Microsurgery

基　　金：浙江省自然科学基金(LY20H270002);浙江中医药科技计划项目(2021ZB060)。

摘　　要：目的探讨应用腓肠肌肌瓣联合载抗生素硫酸钙人工骨治疗老年胫骨平台骨折术后感染伴钢板外露的临床疗效。方法自2015年1月至2019年5月,共收治老年胫骨平台骨折术后感染伴钢板外露患者21例,其中男14例,女7例;年龄61-82岁,平均72.6岁;病程6-91 d,平均22.7 d;切口感染部位:内侧8例,外侧9例,双侧4例;创面大小:2.0 cm×3.5 cm-5.0 cm×12.0 cm。在彻底扩创后,病灶内植入载抗生素硫酸钙人工骨,腓肠肌肌瓣转移覆盖创面,肌瓣表面植皮。门诊和微信随访观察患者肌瓣成活、切口愈合、炎性指标、骨折愈合及膝关节活动等情况,参照McKee感染治疗标准对疗效进行评价,HSS评定标准评价膝关节功能。结果本组21例肌瓣均成活,1例植皮小面积坏死,经过换药后愈合,1例切口出现渗液,但渗液清亮,细菌培养阴性,经2周换药后切口愈合,其余切口均I期愈合,I期愈合率为90%。所有病例均获得随访,随访时间为16-39个月,平均28.7个月。1例术后2个月患处出现红肿,但无渗液,予以抗感染治疗后症状消失无复发;1例术后5个月出现感染复发,予以扩创加拆除钢板后感染得到控制。按照McKee疗效评价,治愈19例,好转1例,复发1例,总有效率95.2%。骨折愈合时间3-7个月,平均4.6个月,膝关节功能根据HSS评分,优12例,良7例,中2例。结论对于老年胫骨平台骨折术后感染伴钢板外露,在彻底扩创后,应用腓肠肌肌瓣联合抗生素硫酸钙人工骨能有效地控制感染,闭合创面,促进骨折愈合,恢复肢体功能。Objective To investigate the clinical efficiency of gastrocnemius muscle flap combined with antibiotics loaded calcium sulfate in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.Methods From January,2015 to May,2019,21 elderly patients with postoperative infection and plate exposure of tibial plateau fracture were treated,including 14 males and 7 females with an average age of 72.6 years,ranging from 61 to 82 years.The average course of disease was 22.7 days,ranging from 6 to 91 days.The site of wound infection was at medial in 8 cases,lateral in 9 cases and bilateral in 4 cases.The size of wound ranged from 2.0 cm×3.5 cm to 5.0 cm×12.0 cm.All wounds were implanted with antibiotics loaded calcium sulfate and repaired by gastrocnemius muscle flap combined with skin graft after debridement.Muscle flap survival,wound healing,inflammatory index,fracture healing and knee joint function were recorded.The curative effect was evaluated by McKee infection treatment criteria and the knee joint function was evaluated by HSS scoring criteria.Results All 21 muscle flaps survived.In 1 case,skin graft necrosis occurred in a small area,and the wound healed well after dressing change.One case had exudation which was clear and the bacterial culturing was negative,and the wound healed after 2 weeks of dressing change.The other incisions were healed in stage I,and the healing rate was 90%.All patients were followed-up for an average of 28.7(16-39)months.The redness and swelling occurred in 1 case without exudation after 2 months which disappeared after anti-infection treatment and didn't recur again.The infection recurred in 1 case after 5 months,and it which was controlled after debridement and plate removal.According to McKee criteria,19 cases were cured,1 improved and 1 recurred with an effective rate of 95.2%.The fracture healing time was from 3 to 7 months,with an average of 4.6 months.According to HSS scoring criteria,the knee joint function was excellent in 12 cases

关 键 词：胫骨平台骨折 感染 硫酸钙 腓肠肌肌瓣 老年 

分 类 号：R687.3[医药卫生—骨科学]