足背动脉岛状皮瓣联合载万古霉素硫酸钙治疗胫骨远端创伤性骨髓炎伴软组织缺损

发布时间：2018-06-03 13:46

本文选题：岛状皮瓣 + 足背动脉　；参考：《中国修复重建外科杂志》2017年05期

【摘要】：目的总结采用逆行足背动脉岛状皮瓣联合载万古霉素硫酸钙植骨治疗合并软组织缺损的胫骨远端创伤性骨髓炎的疗效。方法 2014年3月—2016年4月采用一期彻底清创,足背动脉岛状皮瓣结合载万古霉素硫酸钙植骨治疗胫骨远端创伤性骨髓炎11例。男10例,女1例;年龄43~72岁,平均51.6岁。均为骨折内固定术后所致慢性骨髓炎,病程4周~5个月。骨折原因:交通事故伤5例,高处坠落伤3例,机械绞伤2例,扭伤1例。皮肤软组织缺损范围3 cm×3 cm~13 cm×9 cm;创面细菌培养均为阳性。结果术后2~3周患者切口均Ⅰ期愈合,供受区均未发生感染。11例均获随访,随访时间6个月~2.5年,平均15.5个月。术后骨折均愈合,愈合时间3~9个月,平均4.6个月。末次随访时足部功能采用美国矫形足踝协会(AOFAS)评分,获优9例,良2例;皮瓣感觉S4 8例,S3 2例,S2 1例。所有患者骨髓炎均治愈;1例胫腓骨中下段骨髓炎术后出现骨缺损,大小约4 cm×3 cm,再次手术植入自体髂骨后骨愈合。结论足背动脉岛状皮瓣移植联合万古霉素硫酸钙人工骨植骨治疗伴软组织缺损的胫骨远端创伤性骨髓炎,手术简便有效,是一种较理想的方法。
[Abstract]:Objective to summarize the effect of retrograde dorsal foot artery island flap combined with calcium vancomycin sulfate bone graft in the treatment of traumatic osteomyelitis of distal tibia with soft tissue defect. Methods from March 2014 to April 2016, 11 cases of traumatic osteomyelitis of the distal tibia were treated with one-stage debridement, island flap of dorsal foot artery combined with calcium vancomycin sulfate bone graft. Male 10 cases, female 1 case, the age is 4372 years old, average 51.6 years old. All were chronic osteomyelitis caused by internal fixation of fracture, the course of disease was 4 weeks ~ 5 months. The causes of fracture included traffic accident injury in 5 cases, falling injury in 3 cases, mechanical injury in 2 cases and sprain in 1 case. The area of skin soft tissue defect was 3 cm 脳 3 cm~13 cm 脳 9 cm, and the bacterial culture was positive. Results the incisions healed in the first stage at 2 ~ 3 weeks postoperatively, and no infection occurred in the donor area. All the 11 cases were followed up for 6 months to 2.5 years (mean 15.5 months). The healing time was 3 ~ 9 months (mean 4.6 months). At the last follow-up, the foot function was evaluated with AOFASA score of the American Orthopedic ankle Association (AOAA), 9 cases were excellent, 2 cases were good, and 1 case was S 32 cases with S 38 cases with skin flap sensation. Osteomyelitis was cured in 1 case of osteomyelitis of middle and lower tibia and fibula. The size of bone defect was about 4 cm 脳 3 cm. The bone healed after reimplantation of autogenous iliac bone. Conclusion the transplantation of dorsal foot artery island flap combined with vancomycin calcium sulfate artificial bone graft in the treatment of traumatic osteomyelitis of distal tibia with soft tissue defect is a simple and effective method.
【作者单位】：无锡市第九人民医院(无锡市骨科医院
【分类号】：R687.3

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