皮瓣联合膜诱导技术治疗创伤后胫骨骨髓炎伴软组织缺损  

Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect

作　　者：范金柱 从飞 任小宇 张柯[1] 宋涛[1] FAN Jinzhu;CONG Fei;REN Xiaoyu;ZHANG Ke;SONG Tao(Department of Bone Microsurgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an Shaanxi,710054,P.R.China)

机构地区：[1]西安交通大学附属红会医院骨显微修复外科,西安710054

出　　处：《中国修复重建外科杂志》2022年第5期614-618,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨皮瓣联合膜诱导技术治疗创伤后胫骨骨髓炎伴软组织缺损疗效。方法 回顾分析2015年8月—2018年10月收治且符合选择标准的33例创伤后胫骨骨髓炎伴软组织缺损患者临床资料。男21例,女12例;年龄19~70岁,平均39岁。骨髓炎部位:胫骨上1/3段8例,中1/3段14例,下1/3段11例。骨髓炎根据Cierny-Mader分型标准:Ⅲ型19例,Ⅳ型14例。骨髓炎病程2个月~20年,中位病程3个月。一期彻底清创后,遗留骨缺损长度1.5~12.5 cm,平均5.0 cm;软组织缺损范围5 cm×4 cm~15 cm×12 cm;将含抗生素的骨水泥植入骨缺损部位,皮瓣修复创面;一期术后6~8周创面愈合、感染控制后,二期植骨修复骨缺损。结果一期术后29例皮瓣完全成活;4例局部坏死,经换药等对症处理后愈合。二期术后切口均Ⅰ期愈合。患者均获随访,随访时间24~32个月,平均28个月。术后植骨均愈合,其中影像学愈合时间3~9个月,平均5个月;临床愈合时间4~14个月,平均8个月。随访期间无骨髓炎复发。末次随访时,患肢功能参照JohnerWruhs评定标准,获优27例、良4例、中2例,优良率93.9%。结论 对于创伤后胫骨骨髓炎合并软组织缺损,采用皮瓣联合膜诱导技术治疗可有效恢复下肢功能,临床疗效满意。Objective To investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Methods A clinical data of 33 patients with posttraumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲand 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years(median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm(mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation. Results The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months(mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months(mean, 5 months). The clinical healing time was 4-14 months(mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%.Conclusion For the post-traumatic

关 键 词：胫骨骨髓炎 皮瓣 膜诱导技术 骨缺损 创面修复 

分 类 号：R687.3[医药卫生—骨科学]