万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面中的应用

发布时间：2018-04-25 03:10

本文选题：万古霉素 + 骨水泥　；参考：《中国矫形外科杂志》2016年22期

【摘要】：[目的]探讨万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面及预防跟骨骨髓炎中的临床应用价值。[方法]2012年1月~2015年3月,应用万古霉素骨水泥联合胫后动脉穿支或腓动脉穿支螺旋桨皮瓣修复感染并跟骨骨折骨外露创面13例。其中10例伤口分泌物细菌培养为阳性,创面缺损范围5.0 cm×3.5 cm~8.5cm×7.0 cm。术前用手持普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,清除游离及坏死的骨质;按术前设计切取皮瓣,皮瓣旋转修复创面;在皮瓣下方跟骨缺损或感染严重的区域放置万古霉素骨水泥条1~2根,术后1个月拔出。皮瓣切取范围14.5 cm×4.0 cm~27.0 cm×7.5 cm,8例供区直接缝合,5例供区植皮修复。其中3例因跟骨缺损较多,术后二期行取髂骨植骨术。[结果]术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,创面及供区切口Ⅰ期愈合。患者均获随访,随访时间12~23个月,平均17个月。随访中均未发现创面处感染复发及窦道形成,X线片未见骨髓炎病灶形成。所有皮瓣外形良好。末次随访时根据美国足踝外科协会(AOFAS)评分评价足部功能,足部功能总优良率为76.9%。[结论]万古霉素骨水泥联合螺旋桨皮瓣是修复感染性跟骨外露创面及防治跟骨骨髓炎的有效方法。
[Abstract]:[objective] to evaluate the clinical value of vancomycin cement combined with propeller flap in repairing infected calcaneal exposed wounds and preventing calcaneal osteomyelitis. [methods] from January 2012 to March 2015, 13 cases of infected and calcaneal fracture were treated with vancomycin cement combined with perforating branch of posterior tibial artery or perforating branch of peroneal artery with propeller flap. The bacterial culture of wound secretion was positive in 10 cases, and the area of wound defect was 5.0 cm 脳 3.5 cm~8.5cm 脳 7.0 cm. The perforating fulcrum was located by hand-held puller ultrasound before operation and the design of propeller flap was completed. During the operation, the wound was thoroughly debrided, free and necrotic bone was cleared, the skin flap was cut and rotated to repair the wound as designed before operation, and vancomycin bone cement strips were placed in the area with severe calcaneal defect or infection under the flap. 1 month after operation. The skin grafting was performed in 5 cases with direct suture of donor area in 8 cases with 14. 5 cm 脳 4. 0 cm~27.0 cm 脳 7. 5 cm of flap. Among them, 3 cases were treated with iliac bone graft in the second stage because of more calcaneal defects. [results] the skin flap was successfully removed and repaired during the operation, the flap survived successfully, and the wound and donor incision healed in the first stage. All patients were followed up for 12 ~ 23 months (mean 17 months). No recurrence of infection or sinus formation was found during follow-up. No osteomyelitis focus was found on X-ray films. All flaps are in good shape. At the last follow-up, the total excellent and good rate of foot function was 76.9 according to the AOFAS-score of the American Association of ankle Surgeons. [conclusion] Vancomycin bone cement combined with propeller flap is an effective method for repairing infected calcaneal exposed wounds and preventing and treating calcaneal osteomyelitis.
【作者单位】：第三军医大学研究生管理大队;成都军区昆明总医院全军创伤骨科研究所;
【基金】：全军后勤科研计划面上项目(编号:CCD14J003);全军后勤科研计划重大专项(编号:AWS14C003)
【分类号】：R687.3

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