载抗生素硫酸钙-自体髂骨联合腓肠神经营养皮瓣一期治疗跟骨慢性骨髓炎并皮肤软组织缺损的疗效分析  

Antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap for one-stage treatment of chronic calcaneus osteomyelitis plus skin and soft tissue defects

作　　者：苏雨 任程[2] 马腾[2] 李明[2] 杜兵 姬帅 李东晨 张堃[2] 李忠[2] Su Yu;Ren Cheng;Ma Teng;Li Ming;Du Bing;Ji Shuai;Li Dongchen;Zhang Kun;Li Zhong(Medical College,Yan'an University,Yan'an 716000,China;Department of Orthopaedic Trauma,Xi'an Honghui Hospital Affiliated to Medical College,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]延安大学医学院,延安716000 [2]西安交通大学医学院附属红会医院创伤下肢病区,西安710054

出　　处：《中华创伤骨科杂志》2023年第3期233-241,共9页Chinese Journal of Orthopaedic Trauma

基　　金：陕西省自然科学基金(2022JQ-299)。

摘　　要：目的探讨载抗生素硫酸钙-自体髂骨联合腓肠神经营养皮瓣一期治疗跟骨慢性骨髓炎并皮肤软组织缺损的临床疗效。方法回顾性分析2013年1月至2019年9月期间西安交通大学医学院附属红会医院创伤下肢病区收治的48例跟骨慢性骨髓炎并皮肤软组织缺损患者资料。根据植骨材料不同分为两组:A组26例,男16例,女10例;年龄为(45.0±11.7)岁;皮肤缺损面积为(56.0±16.7)cm2;采用载抗生素硫酸钙-自体髂骨联合腓肠神经营养皮瓣一期治疗。B组22例,男13例,女9例;年龄为(43.6±9.6)岁;皮肤缺损面积为(53.8±16.2)cm2;采用单纯自体髂骨联合腓肠神经营养血管皮瓣一期治疗。比较两组患者的髂骨切取体积、骨折愈合时间、感染控制率、供区并发症发生率、疼痛视觉模拟评分(VAS)及足踝功能等。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。48例患者术后获(15.3±6.0)个月随访。A组患者髂骨切取体积[(67.3±14.1)cm3]显著少于B组患者[(90.7±23.5)cm3],供区并发症发生率[3.8%(1/26)]显著低于B组患者[31.8%(7/22)],术后6、12、24、48、72 h疼痛VAS评分显著低于B组患者,术后2、4、8周白细胞计数、红细胞沉降率和C-反应蛋白也显著低于B组患者,差异均有统计学意义(P<0.05)。A组和B组患者的感染控制率分别为96.2%(25/26)、77.3%(17/22),骨折愈合时间分别为(6.2±1.9)、(6.4±2.1)个月,术后6个月美国足踝外科协会踝-后足评分分别为(83.9±7.2)、(82.5±8.7)分,差异均无统计学意义(P>0.05)。结论与单纯自体髂骨相比,载抗生素硫酸钙-自体髂骨联合腓肠神经营养血管皮瓣一期治疗跟骨慢性骨髓炎并皮肤软组织缺损能减少髂骨切取量,降低疼痛VAS评分和供区并发症发生率,提高炎性指标恢复速度,疗效良好。Objective To investigate the clinical effects of antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap in the one-stage treatment of chronic calcaneus osteomyelitis plus skin and soft tissue defects.Methods From January 2013 to September 2019,48 patients were admitted to Department of Orthopedic Trauma,Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University for chronic calcaneal osteomyelitis complicated with skin and soft tissue defects.They were divided into 2 groups according to different bone grafts.In group A of 26 patients treated at one stage by antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap,there were 16 males and 10 females with an age of(45.0±11.7)years and an area of skin defect of(56.0±16.7)cm2.In group B of 22 patients treated at one stage by simple autologous iliac bone combined with sural neurocutaneous flap,there were 13 males and 9 females with an age of(43.6±9.6)years and an area of skin defect of(53.8±16.2)cm2.The volume of the ilium harvested,fracture healing time,infection control,donor site complications,pain score of visual analogue scale(VAS)and function recovery of the ankle were compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).The 48 patients were followed up for(15.3±6.0)months.Group A had a significantly smaller volume of the ilium harvested[(67.3±14.1)cm3]than group B[(90.7±23.5)cm3],a significantly lower rate of donor site complications[3.8%(1/26)]than group B[31.8%(7/22)],significantly lower VAS pain scores at 6,12,24,48 and 72 hours than group B,and significantly lower WBC count,erythrocyte sedimentation rate and C-reactive protein at 2,4,8 weeks after operation than group B(all P<0.05).There was no statistically significant difference between the 2 groups in the infection control rate[96.2%(25/26)versus 77.3%(17/22)],the fracture healing time[(6.2±1.9)months versus(6.4�

关 键 词：跟骨 骨髓炎 外科皮瓣 创伤和损伤 移植 自体 硫酸钙 

分 类 号：R658.3[医药卫生—外科学]