可吸收载抗菌药物硫酸钙联合组织瓣治疗儿童足跟部皮肤软组织缺损继发创伤性跟骨骨髓炎  

Treatment of traumatic calcaneal osteomyelitis secondary to skin and soft tissue defects in children via absorbable antibacterial calcium sulfate combined with tissue flaps

作　　者：邵锋[1] 王天刚[1] 周一航 吴俊涛[1] 张春旺 宋力 肖滋润 Shao Feng;Wang Tiangang;Zhou Yihang;Wu Juntao;Zhang Chunwang;Song Li;Xiao Zirun(Department of Traumatology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Institute of International Education,Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Hospital of the Joint Logistic Support Force of the PLA,Zhengzhou 450001,China)

机构地区：[1]新乡医学院第三附属医院创伤外科,河南新乡453003 [2]新乡医学院国际教育学院,河南新乡453003 [3]中国人民解放军联勤保障部队第九八八医院创伤显微骨科,郑州450001

出　　处：《中华实用儿科临床杂志》2021年第13期1019-1022,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨采用可吸收载抗菌药物硫酸钙联合组织瓣治疗儿童足跟部皮肤软组织缺损继发创伤性跟骨骨髓炎的可行性及临床疗效。方法2007年1月至2020年8月新乡医学院第三附属医院共治疗儿童足跟部皮肤软组织缺损伴创伤性跟骨骨髓炎并获取有效随访病例44例,其中采用可吸收硫酸钙联合组织瓣治疗17例为硫酸钙组,采用载抗菌药物聚甲基丙烯酸甲酯(PMMA)骨水泥链珠膜诱导联合组织瓣治疗27例作为膜诱导组,比较2组治疗效果、术后感染复发率、术后踝关节活动度、手术次数、总住院时间、住院费用等方面的差异。结果硫酸钙组随访时间平均为10.7个月,膜诱导组平均为9.3个月。除3例腓肠神经营养血管皮瓣远端小面积坏死外,其他皮瓣均顺利成活。硫酸钙组的术后感染复发率、住院费用低于膜诱导组,但差异无统计学意义(均P>0.05)。硫酸钙组患儿的术后踝关节活动度[(63.6±9.3)°]、手术次数[2(1.0,2.0)次]、住院时间[6.1(4.5,7.5)周]低于膜诱导组[(57.7±9.5)°,2(2.0,3.0)次,7.0(5.0,9.0)周],差异均有统计学意义(均P<0.05)。严重跟骨骨髓炎可能导致跟骨结节或跟腱止点结构破坏,但主动跖屈功能良好,屈曲力量有所降低。结论采用可吸收载抗菌药物硫酸钙联合组织瓣治疗儿童创伤性跟骨骨髓炎效果良好,手术次数、住院时间、住院费用相较于PMMA骨水泥联合组织瓣方法更少。Objective To explore the feasibility and clinical results of absorbable antibacterial calcium sulfate combined with tissue flaps in the treatment of traumatic calcaneal osteomyelitis(CO)secondary to skin and soft tissue defects in children.Methods From January 2007 to August 2020,44 cases of children with heel skin and soft tissue defects associated with traumatic CO were treated and followed up effectively in the Third Affiliated Hospital of Xinxiang Medical University.Among them,17 cases were treated with absorbable calcium sulfate cement combined with tissue flaps as the calcium sulfate group,and 27 cases were treated with antibiotic polymethylmethacrylate(PMMA)bead combined with tissue flaps as the membrane induction group.A comparison was drawn on the therapeutic effect,recurrence rate of postoperative infection,postoperative ankle mobility,number of operations,total length of hospital stays and hospitalization expenses between both groups.Results The average follow-up time was 10.7 months in the calcium sulfate cement group and 9.3 months in the membrane induction group.All flaps were effective except for 3 cases who presented with small necrosis on the distal end of the sural neurovascular flaps.The recurrence rate of postoperative infection and the hospitalization expenses in the calcium sulfate group were lower than those in the membrane induction group,but the differences were not statically significant(all P>0.05).The postoperative ankle mobility[(63.6±9.3)°],number of operations[2(1.0,2.0)times]and total length of hospital stay[6.1(4.5,7.4)weeks]of the calcium sulfate group were significantly lower than those of the membrane induction group[(57.7±9.5)°,2(2.0,3.0)times,7.0(5.0,9.0)weeks],the difference were statistically significant(all P<0.05).Severe CO may cause structural damage to calcaneal tubercle or insertion site of achilles tendon,but the active plantar flexion function of ankles will be good despite the decrease in strength.Conclusions The effect of absorbable antibacterial calcium sulfat

关 键 词：硫酸钙 创伤性跟骨骨髓炎 组织瓣 骨水泥 儿童 

分 类 号：R726.8[医药卫生—儿科]