抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果  

Effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy

作　　者：李汉华[1] 熊兵 刘族安 黄志锋 孙传伟 罗红敏 马亮华 卞徽宁 郑少逸 赖文 Li Hanhua;Xiong Bing;Liu Zu'an;Huang Zhifeng;Sun Chuanwei;Luo Hongmin;Ma Lianghua;Bian Huining;Zheng Shaoyi;Lai Wen(Department of Burns and Wound Repair Surgery,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Burns and Wound Repair Surgery,Burns and Wound Repair Institute,Shenzhen People's Hospital,Shenzhen 518000,China)

机构地区：[1]烧伤与创面修复外科,南方医科大学附属广东省人民医院(广东省医学科学院),广州510080 [2]深圳市人民医院烧伤创面修复研究所,烧伤创面修复外科,深圳518000

出　　处：《中华烧伤与创面修复杂志》2024年第5期461-467,共7页Chinese Journal of Burns And Wounds

基　　金：广东省基础与应用基础研究区域联合基金重点项目(2020B1515120088);广州市科技基础与应用基础研究项目(202102080323)。

摘　　要：目的探讨采用抗菌可吸收缝线拉拢闭合术修复正中开胸术后因胸骨深部伤口感染致小范围骨缺损创面的效果。方法该研究为回顾性非随机临床对照研究。将2017年10月—2021年12月南方医科大学附属广东省人民医院(以下简称本院)收治的32例[男20例、女12例,年龄(58±11)岁]符合入选标准且实施抗菌可吸收缝线拉拢闭合术(以下简称直接闭合术)的患者纳入直接闭合组,将2015年1月—2020年1月本院收治的39例[男27例、女12例,年龄(59±11)岁]符合入选标准且实施双侧胸大肌肌瓣填塞修复术的患者纳入肌瓣填塞组。Ⅰ期对胸骨感染创面彻底清创后行Ⅱ期创面修复术。2组患者清创后的胸骨横截面缺损宽度均<1 cm。直接闭合组患者的Ⅱ期创面修复术为采用双线间断缝合胸骨前板或胸骨全层6处或7处。统计2组患者Ⅱ期创面修复术的时长及术中出血量、住院时间以及创面感染细菌情况。统计2组患者术后并发症情况及创面愈合情况。随访时,观察2组患者创面是否存在感染或复发情况以及直接闭合组患者胸骨愈合情况。结果与肌瓣填塞组相比,直接闭合组患者Ⅱ期创面修复术的时长和住院时间均明显缩短(t值分别为13.61、6.25,P<0.05)、Ⅱ期创面修复术的术中出血量无明显变化(P>0.05)。2组患者感染的细菌以葡萄球菌为主。直接闭合组中1例患者术后2周创面处有渗液,经保守换药治疗2周后创面愈合良好;其余患者创面均愈合良好。肌瓣填塞组中5例患者出现术后并发症,其中1例患者死亡、4例患者创面经换药或再次手术后愈合;其余患者创面均愈合良好。2组患者并发症发生情况比较,差异无统计学意义(P>0.05)。随访22~45个月,直接闭合组患者与肌瓣填塞组存活患者创面均未见再次感染或复发。直接闭合组患者胸骨均达到解剖愈合。结论直接闭合术不仅能在早期有效修复正中开胸术后Objective To investigate the effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy.Methods This study was a retrospective non-randomized clinical controlled study.A total of 32 patients(20 males and 12 females,aged(58±11)years)who met the inclusion criteria and underwent closure with antibacterial absorbable sutures(hereinafter referred to as direct closure surgery)admitted to Guangdong Provincial People's Hospital of Southern Medical University(hereinafter referred to as our hospital)from October 2017 to December 2021 were included in direct closure group.A total of 39 patients(27 males and 12 females,aged(59±11)years)who met the inclusion criteria and received bilateral pectoralis major muscle flap packing repair admitted to our hospital from January 2015 to January 2020,were included in muscle flap packing group.In the two groups,sternal infected wounds were thoroughly debrided during stageⅠsurgery,followed by wound repair during stageⅡsurgery.The width of sternal cross-section defects after debridement was less than 1 cm for patients in the two groups.For patients in direct closure group,stageⅡwound repair involved intermittent sutures to the anterior sternal plate or full-thickness sternum with a total of 6 or 7 double sternal sutures.Relevant data including the duration of the stageⅡwound repair surgery and the volume of blood loss during surgery,length of hospital stay,and bacterial wound infection of patients in the two groups were recorded.The postoperative complications and wound healing of patients in the two groups were recorded.During follow-up,the wound infection or recurrence of patients in the two groups and the sternal healing of patients in direct closure group were observed.Results Compared with those in muscle flap packing group,the duration of stageⅡwound repair surgery and length of hospital stay of patients in direct closure group were significantly shorter(with t values

关 键 词：清创术 胸骨切开术 外科伤口感染 抗菌可吸收缝线拉拢闭合 骨缺损 创面修复 

分 类 号：R687.3[医药卫生—骨科学]