髋关节离断大腿剔骨肌皮瓣修复髋周难治性压疮  

Repairing of Peri-hip Refractory Pressure Ulcers with Thigh-Musculocutaneous Flap after Hip Disarticulation

作　　者：黄书润[1] 张勇[1] 刘江涛 欧阳容兰[1] 庄美平 HUANG Shu-run;ZHANG Yong;LIU Jiang-tao;OUYANG Rong-lan;ZHUANG Mei-ping(Department of Burns and Plastic Surgery,the 910th Hospital of Joint Logistic Force of Chinese People's Liberation Army,Quanzhou 362000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院烧伤整形科,福建泉州362000

出　　处：《中国现代手术学杂志》2021年第4期289-292,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨髋关节离断大腿剔骨肌皮瓣修复治疗危及生命的髋周难治性压疮的疗效。方法回顾性分析2016年12月至2018年12月收治的6例双下肢截瘫后髋周难治性压疮患者的临床资料,均存在2处以上Ⅳ期压疮,单个压疮体表面积(2 cm×3 cm)~(22 cm×15 cm),其中5例合并化脓性髋关节炎,2例伴髋关节脱位,4例既往行压疮修复手术2~4次。均采用单侧股骨上段截骨、髋关节离断后剔除股骨、大腿肌皮瓣修复残端及压疮创面。结果本组6例均一次手术修复,大腿剔骨肌皮瓣成活好,5例创面一期愈合,1例切口小部分裂开,换药后痊愈。随访5个月~2年,患者生活质量明显改善,生活基本自理。5例压疮无复发,1例术后1年其他部位受压溃烂,再行皮瓣修复。结论对于反复发作且危及生命的髋周难治性压疮,采用髋关节离断股骨剔除、大腿肌皮瓣修复创面,可以挽救生命,减少压疮复发,提高生活质量,是一种有效的治疗方法。Objective To discuss the therapeutic effect of repairing of life-threatening peri-hip refractory pressure ulcers with thigh-musculocutaneous flap after hip disarticulation.Methods The clinical data of 6 cases with paraplegia in bilateral lower limbs suffered peri-hip refractory pressure ulcers admitted from December 2016 to December 2018 were reviewed.There were two or more lesions with stageⅣpressure ulcers per one patient.The surface wound of pressure ulcer sized from 2 cm×3 cm to 22 cm×15 cm.Of the 6 patients,5 cases combined with suppurative hip arthritis and 2 cases with hip dislocation.All cases were performed lateral upper femoral osteotomy,hip disarticulation and thigh-musculocutaneous flap repairing.Results All thigh-musculocutaneous flaps were survived well in 6 cases by repair surgery at one time.The primary wound healing was achieved in 5 cases,and a small part of wound was found dehiscence in one case and cured by change dressing.All cases were followed up for 5 months to 2 years.The quality of life was improved significantly in all 6 cases.No recurrence of pressure ulcer occurred in 5 cases,and pressure ulcer was found in other parts in one case one year after the operation and re-repaired by musculocutaneous flap.Conclusion The surgery of lateral upper femoral osteotomy,hip disarticulation and thigh-musculocutaneous flap repairing can save the life,reduce the recurrence of pressure ulcer and improve the quality of life,it is an effective therapy for recurrent and life-threatening peri-hip refractory pressure ulcers.

关 键 词：溃疡 压力性 肌皮瓣 截瘫 髋关节离断术 

分 类 号：R632.1[医药卫生—外科学]