开放性骨水泥技术结合胸大肌推进肌瓣治疗冠脉搭桥术后慢性胸骨骨髓炎  

Exposed bone cement technique and pectoralis major advancement muscle flap in treatment of chronic sternal osteomyelitis after coronary artery bypass surgery

作　　者：徐鹏 薛明宇 王进 郭晓峰 卜凡玉 XU Peng;XUE Mingyu;WANG Jin;GUO Xiaofeng;BU Fanyu(Wuxi 9th Affiliated Hospital of Soochow University,Wuxi,Jiangsu Province 214062,China)

机构地区：[1]苏州大学附属无锡市第九人民医院,江苏无锡214062

出　　处：《中华显微外科杂志》2022年第2期133-138,共6页Chinese Journal of Microsurgery

基　　金：无锡市卫生健康委员会适宜技术推广项目(T201755);无锡市政府太湖人才计划项目(2020WXTH-14)。

摘　　要：目的分析开放性骨水泥技术结合胸大肌推进肌瓣分期治疗冠脉搭桥术(CABS)后慢性胸骨骨髓炎的疗效,总结分期手术、综合治疗的临床经验。方法回顾性分析2017年10月至2020年6月收治的CABS后胸骨慢性骨髓炎开放性骨水泥技术治疗的患者5例,年龄54~72岁,冠心病病史5~12年,入院时慢性胸骨骨髓炎时间3周~3个月。围手术期整体把控患者全身情况并进行全身营养支持治疗,所有患者均一期行彻底清创加开放性骨水泥技术加VSD以控制感染,二期行骨水泥取出并行胸大肌推进肌瓣填塞死腔,术后密切观察患者伤口张力情况、引流管通畅情况及引流情况。出院后随访时观察患者伤口愈合情况、瘢痕增生问题及有无并发症发生。结果术后伤口缝线张力适中,引流管引流通畅,引出少量血性液体,引流液无浑浊。所有患者均临床治愈并获随访,随访时间6~15个月,随访期间无骨髓炎复发或再次形成窦道,末次随访均未出现明显并发症。患者生活质量明显改善,均对疗效表示满意。结论开放性骨水泥技术结合胸大肌推进肌瓣是治疗CABS胸骨慢性骨髓炎的有效方法,短期疗效好,值得临床推广应用。Objective To analyse the effect of the exposed bone cement technique combined with pectoralis major muscle flap in the treatment of chronic sternal osteomyelitis after coronary artery bypass surgery(CABS),and to summarise the clinical experience of staged surgery and comprehensive treatment.Methods A retrospective analysis were carried out on 5 patients who had chronic sternal osteomyelitis and treated with exposed bone cement after the CABS from October 2017 to October 2020.Five patients(4 males and 1 female)met the inclusion criteria with a mean age of 65(range from 54 to 72)years old.Duration of all the chronic sternal osteomyelitis was 3 weeks to 3 months at admission.During the perioperative period,the general condition of the patients was controlled and systemic nutritional support was given.At the first stage,all patients underwent complete debridement.Then all the wounds were treated with exposed bone cement and covered by vacuum sealing drainage(VSD)to control the infection.At the second stage,bone cement was removed,and the dead cavity was packed with pectoralis major advancement muscle flap.Close attention was paid to the tension of wound,the patency of drainage catheter and the drainage after surgery.The wound healing,scar hyperplasia and complications were observed during the follow-up.Results The suture tension was moderate,the drainage catheter was unobstructed,and a little liquid was drawn without turbid.All patients were clinically cured and entered follow-up for 6 to 15 months.During the follow-up,there was neigher recurrence of osteomyelitis nor sinus tract formation.No significant complication occurred at the last follow-up.The quality of life of the patients was significantly improved and all the patients were satisfactory to the treatment.Conclusion Exposed bone cement technique combined with pectoralis major muscle flap is an effective method in the treatment of chronic sternal osteomyelitis after CABS.It has a good short-term treatment efficacy and is worthy for further clinical trials.

关 键 词：冠脉搭桥术 胸骨骨髓炎 开放性骨水泥技术 抗生素骨水泥 

分 类 号：R687.3[医药卫生—骨科学]