小腿组织瓣联合载抗生素硫酸钙人工骨治疗足踝部骨髓炎的疗效分析  

A calf tissue flap combined with antibiotic-loaded calcium sulfate for foot and ankle osteomyelitis

作　　者：刘刚义 张洁 张锦涛 杨伟超 王春旭 李建梅 李晓妮 王芳 乔林[2] Liu Gangyi;Zhang Jie;Zhang Jintao;Yang Weichao;Wang Chunxu;Li Jianmei;Li Xiaoni;Wang Fang;Qiao Lin(Department of Hand and Microsurgery,The Third Hospital of Baoji,Baoji 721000,China;Department of Orthopeadics,The 987 Hospital of PLA,Baoji 721004,China)

机构地区：[1]宝鸡第三医院手显微外科,宝鸡721000 [2]中国人民解放军联勤保障部队第九八七医院骨科,宝鸡721004

出　　处：《中华创伤骨科杂志》2023年第4期361-365,共5页Chinese Journal of Orthopaedic Trauma

基　　金：宝鸡市卫健委科研计划项目(2021-060)。

摘　　要：目的:观察小腿组织瓣联合载抗生素硫酸钙人工骨治疗足踝部骨髓炎的疗效。方法:回顾性研究2018年10月至2021年10月期间宝鸡第三医院手显微外科应用小腿组织瓣联合载抗生素硫酸钙人工骨(或混合髂骨植骨)治疗的11例足踝部骨髓炎患者资料。男8例,女3例;年龄(42.3±23.7)岁。对慢性低毒性骨髓炎,彻底扩创后应用小腿组织瓣联合载抗生素硫酸钙人工骨一期填塞空腔、覆盖创面,修复重建。对感染急性期创面,先局部换药、引流或扩创后负压封闭吸引,全身抗感染治疗;待急性感染控制并稳定后再彻底扩创、应用小腿组织瓣联合载抗生素硫酸钙人工骨填塞空腔、覆盖创面,修复重建。组织瓣切取面积为3.5 cm×2.0 cm~12.0 cm×6.0 cm。应用腓动脉穿支蒂皮瓣联合载抗生素硫酸钙人工骨治疗4例,腓动脉穿支蒂腓肠神经营养血管皮瓣联合载抗生素硫酸钙人工骨治疗3例,胫后动脉穿支蒂皮瓣联合载抗生素硫酸钙人工骨治疗3例,腓骨长肌肌瓣联合载抗生素硫酸钙人工骨治疗1例。术后观察皮瓣的成活情况、骨愈合时间、踝关节功能及并发症发生情况,末次随访时感染控制情况[包括局部红肿疼痛、有无破溃、渗出等临床表现,血液白细胞计数(WBC)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原]以评价疗效。结果:除1例皮瓣远1/3坏死,经换药愈合外,其余组织瓣均顺利成活。所有患者术后获(22.6±11.5)个月随访。术后6个月所有组织瓣外形、质地均良好。复查WBC、CRP、ESR、降钙素原等指标均恢复正常或接近正常,局部皮肤无红肿、破溃,且不同程度地恢复保护性感觉。除1例术后18个月复查X线片示骨愈合不良外(但无其他不良症状或体征),其余患者依X线片示(12.1±2.3)个月病灶均消失,并达到骨性愈合;踝关节恢复基本屈伸功能,患肢也恢复负重及行走功能。结论:应用小腿组织瓣联合载抗Objective To evaluate the efficacy of a calf tissue flap combined with antibiotic-loaded calcium sulfate(artificial bone or mixed iliac bone graft)in the treatment of foot and ankle osteomyelitis.Methods A retrospective study was conducted to analyze the 11 cases of foot and ankle osteomyelitis which had been treated at Department of Hand and Microsurgery,The Third Hospital of Baoji from October 2018 to October 2021.There were 8 males and 3 females,aged(42.3±23.7)years.The chronic hypotoxic osteomyelitis was repaired and reconstructed after thorough debridement at one stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound.The acute infected trauma was repaired and reconstructed after thorough debridement at the second stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound only after the acute infection was controlled by local dressing,drainage or negative pressure therapy and systemic anti-infection treatment at the primary stage.The flap size ranged from 3.5 cm×2.0 cm to 12.0 cm×6.0 cm.Four cases were treated by a peroneal artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone,3 cases by a flap with peroneal artery perforator and peroneal nerve trophic vessel combined with antibiotic-loaded calcium sulfate artificial bone,3 cases by a posterior tibial artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone,and one by a peroneus longus muscle flap combined with antibiotic-loaded calcium sulfate artificial bone.Postoperatively,the flap survival,bone union time,ankle function and complications were observed;the therapeutic efficacy was evaluated by comparing infection control indexes at the final follow-up[clinical manifestations like local redness,swelling,pain,ulceration,and exudation,and white blood cell count(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and calcitoninogen(PC

关 键 词：踝损伤 骨髓炎 外科皮瓣 硫酸钙 万古霉素 显微外科手术 

分 类 号：R681.2[医药卫生—骨科学]