分期手术治疗跟骨创伤性骨髓炎

发布时间：2018-04-27 02:33

本文选题：跟骨 + 骨髓炎　；参考：《中医正骨》2016年10期

【摘要】：目的:观察一期病灶清除联合负压封闭引流和二期载抗生素人工骨植骨联合腓动脉穿支皮瓣修复治疗跟骨创伤性骨髓炎的临床疗效及安全性。方法:2010年7月至2015年7月,采用一期病灶清除联合负压封闭引流和二期载抗生素人工骨植骨联合腓动脉穿支皮瓣修复治疗跟骨创伤性骨髓炎患者23例,男18例、女5例。年龄21~66岁,中位数39岁。开放性骨折10例,闭合性骨折13例。左侧9例,右侧14例。所有患者均接受过跟骨骨折切开复位内固定术,均有切口红肿、反复渗液等临床表现,影像学检查显示均存在不同程度的骨坏死及窦道形成。病程3个月至2年,中位数13个月。随访观察骨髓炎治疗情况和皮瓣成活、植骨愈合、并发症发生及足部功能恢复情况。结果:所有患者均获随访,随访时间6~28个月,中位数15个月。所有患者骨髓炎均治愈,随访期间无复发。皮瓣均成活,外观良好,色泽、弹性与周围正常皮肤接近,无溃疡及窦道形成。供区创面均愈合,且瘢痕较小。植骨均愈合,愈合时间7~10个月,中位数8个月。均未出现感染及骨坏死等并发症。采用Maryland足部功能评分标准评价疗效,优11例、良9例、可3例。结论:一期病灶清除联合负压封闭引流和二期载抗生素人工骨植骨联合腓动脉穿支皮瓣修复治疗跟骨创伤性骨髓炎,骨髓炎治愈率高、皮瓣成活好、植骨愈合率高、并发症少、足部功能恢复良好,值得临床推广应用。
[Abstract]:Objective: To observe the clinical efficacy and safety of one-stage debridement combined with negative pressure closed drainage and two stage antibiotic artificial bone graft combined with peroneal perforator flap for the treatment of traumatic osteomyelitis of the calcaneus. Methods: from July 2010 to July 2015, the first phase clearance combined with negative pressure closed drainage and two stage antibiotic artificial bone graft were used. The combined fibula perforator flap was used to repair 23 patients with traumatic osteomyelitis of the calcaneus, 18 men and 5 women. The age was 21~66 years old and the median was 39 years. 10 open fractures, 13 closed fractures, 9 left side and 14 on the right. All patients had undergone open reduction and internal fixation of calcaneal fracture. All patients had clinical manifestations such as redness and swelling of the incision and percolation. Osteonecrosis and sinus formation were found in different degrees. The course of the disease was 3 months to 2 years and median 13 months. The treatment of osteomyelitis and skin flap survival, bone healing, complications and foot function recovery were followed up. All patients were followed up for 6~28 months, median of 15 months. All the myelositis were cured and no recurrence during the follow-up period. The skin flap survived, the appearance was good, the color, the elasticity and the surrounding normal skin were close, no ulcer and sinus formation. The donor wound healing was healed, and the scar was smaller. The bone healing time was 7~10 months, the median 8 months. No complications such as infection and osteonecrosis were found. Maryland foot function evaluation was used. The results were as follows: 11 cases were excellent, good 9 cases, and 3 cases. Conclusion: first phase clearance combined with negative pressure closed drainage and two stage antibiotic artificial bone graft combined with peroneal perforator flap for the treatment of traumatic osteomyelitis of calcaneus, high cure rate of osteomyelitis, good flap survival, high bone healing rate, less complications and good foot function recovery. Clinical application.

【作者单位】：浙江省绍兴市柯桥区中医医院;
【分类号】：R687.3

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