抗生素骨水泥植入联合游离嵌合组织瓣移植序贯治疗严重痛风性创面的临床效果  

Clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds

作　　者：肖顺娥 李海 张天华 吴祥奎 吴必华 魏在荣 邓呈亮 Xiao Shun'e;Li Hai;Zhang Tianhua;Wu Xiangkui;Wu Bihua;Wei Zairong;Deng Chengliang(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,遵义563000

出　　处：《中华烧伤与创面修复杂志》2025年第1期53-60,共8页Chinese Journal of Burns And Wounds

基　　金：贵州省高层次创新型人才“千”层次人才(xmrc120240201);省部共建协同创新中心项目(教科技厅函〔2020〕39号)。

摘　　要：目的探讨抗生素骨水泥植入联合游离嵌合组织瓣移植序贯治疗严重痛风性创面的临床效果。方法该研究为回顾性观察性研究。2019年7月—2022年7月,遵义医科大学附属医院收治11例符合入选标准的严重痛风性创面患者,均为男性,年龄33~71岁。创面位于手部者2例、踝部者5例、足部者4例。清创后,创面面积为5.0 cm×4.0 cm~22.0 cm×6.0 cm,均采用抗生素骨水泥植入联合游离嵌合组织瓣移植序贯修复。采用游离旋髂浅动脉穿支嵌合骨皮瓣修复者2例,切取皮瓣面积分别为5.5 cm×4.0 cm、8.0 cm×6.0 cm,切取髂骨瓣体积分别为2.0 cm×2.0 cm×1.5 cm、3.5 cm×2.0 cm×2.0 cm;采用游离旋髂深动脉穿支嵌合骨皮瓣修复者2例,切取皮瓣面积分别为6.0 cm×4.0 cm、7.5 cm×5.0 cm,切取髂骨瓣体积分别为2.0 cm×1.5 cm×1.5 cm、2.5 cm×2.0 cm×1.5 cm;采用游离旋股外侧动脉降支穿支嵌合肌皮瓣修复者7例,切取皮瓣面积为9.5 cm×6.0 cm~25.0 cm×6.5 cm,肌瓣体积为4.0 cm×3.0 cm×2.0 cm~6.0 cm×5.0 cm×2.5 cm。直接缝合供区创面。将嵌合组织瓣游离移植至受区创面,其中的髂骨瓣用于填塞骨缺损,肌瓣用于填塞创腔,皮瓣用于覆盖创面;血管蒂中的动静脉与受区动静脉吻合。观察患者入院时及抗生素骨水泥植入术后3 d白细胞计数、中性粒细胞及超敏C反应蛋白水平变化情况以及创面分泌物标本细菌培养情况,创基肉芽组织生长情况。Ⅱ期术后,观察移植嵌合组织瓣成活情况、是否发生血管危象,供、受区创面愈合情况。随访时,观察受区移植组织瓣血运、外观及质地,观察患肢、患指功能及外观,观察供、受区并发症发生情况。结果抗生素骨水泥植入术后3 d,患者白细胞计数、超敏C反应蛋白水平及中性粒细胞均较入院时显著下降(Z值分别为-2.93、-2.93,t=8.63,P<0.05)。入院时,11例患者创面均存在细菌感染,创周红肿明显;抗生素骨水泥植入术后3 Objective To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.MethodsThis study was a retrospective observational study.From July 2019 to July 2022,11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University.The wounds were located on the hands in 2 cases,the ankles in 5 cases,and the feet in 4 cases.After debridement,the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm.All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation.Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps,with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm,respectively,and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm,respectively.Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps,with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm,respectively,and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm,respectively.Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery.The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm,and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm.The donor site wounds were directly sutured.The chimeric tissue flap was freely transplanted to the recipient wound site,of which the iliac bone graft was used to fill the bone defect,the muscle flap was utilized to fill the wound cavity,and the skin flap was employed to cover the wound surface;the arteries and veins in the vascular ped

关 键 词：痛风 显微外科手术 游离皮瓣 嵌合皮瓣 抗生素骨水泥 创面修复 

分 类 号：R622[医药卫生—整形外科]