负压封闭吸引联合开放性植骨或骨搬移治疗胫骨创伤性骨髓炎

发布时间：2018-10-26 12:26

【摘要】：目的:探讨负压封闭吸引(vacuum sealing drainage,VSD)联合开放性植骨或骨搬移技术治疗胫骨创伤性骨髓炎合并皮肤软组织缺损的临床疗效。方法:回顾性分析2012年1月~2013年9月本院收治且获得完整随访的24例胫骨创伤性骨髓炎患者的临床资料,男16例,女8例;年龄22~61岁,平均41.5岁。术前均行创面细菌培养+药敏试验、X片及CT三维重建检查。清创后胫骨缺损长度2~9cm,平均(5.96±2.14)cm;创面范围为3cm×3 cm~9 cm×7 cm,平均(25.63±17.44)cm2。对5例骨缺损"f4cm病例采用清创、VSD(负压封闭吸引)、开放性植骨治疗;对19例骨缺损4cm病例采用清创、VSD、骨搬移治疗。结果:24例患者获随访10~18个月,平均13.3个月。24例患者抗生素使用天数5-14天,平均7.9天。VSD治疗0~10次,平均2.9次。2例患者创面清创后可直接缝合,其余22例患者创面均愈合。19例患者骨端自然愈合,愈合时间4~15月,平均6.4月;5例患者采用骨搬移治疗后出现断端骨不连,通过清理骨端皮肤及软组织嵌顿、打通骨髓腔、自体髂骨植骨及VSD治疗后达到骨端愈合。2例患者治疗期间出现钉道感染,应用抗生素治疗后感染控制,其余患者无感染复发。术后1、2个月随访软组织缺损面积均较术中显著改善,差异有统计学意义(P0.05);按Paley骨折愈合评分标准:优19例,良3例,中2例,差0例。优良率为91.6%。结论:VSD联合开放性植骨或骨搬移技术是治疗胫骨创伤性骨髓炎合并皮肤软组织缺损的有效方法。
[Abstract]:Objective: to investigate the clinical effect of (vacuum sealing drainage,VSD combined with open bone grafting or bone transfer in the treatment of traumatic osteomyelitis of tibia with skin and soft tissue defect. Methods: the clinical data of 24 patients with traumatic osteomyelitis of tibia treated in our hospital from January 2012 to September 2013 were analyzed retrospectively, including 16 males and 8 females, aged 2261 years with an average of 41.5 years. The bacterial culture sensitivity test, X-ray and three-dimensional CT reconstruction were performed before operation. After debridement, the length of tibial defect was 2? 9 cm, with an average of (5. 96 卤2. 14) cm; wound area of 3cm 脳 3 cm~9 cm 脳 7 cm, and an average of (25.63 卤17. 44) cm2.? Five cases of f4cm with bone defect were treated by debridement of, VSD (negative pressure and suction), and 19 cases of 4cm with bone defect were treated with debridement and VSD, bone transfer. Results: 24 patients were followed-up for 10 ~ 18 months (mean 13.3 months), 24 patients were treated with antibiotics for 5-14 days (average 7.9 days), VSD was used for 10 times (average 2. 9 times), and 2 cases were treated with direct suture after debridement. 19 cases healed naturally, the healing time was 4 ~ 15 months (mean 6.4 months). Bone nonunion was found in 5 patients after bone transfer. Bone marrow cavity was opened by clearing the skin and soft tissue incarceration of bone end, autogenous iliac bone graft and VSD treatment were used to achieve bone end healing, 2 patients developed nail infection during treatment. Infection was controlled after antibiotic therapy, and no infection recurred in other patients. The area of soft tissue defect was significantly improved at 1 and 2 months after operation (P0.05). According to Paley fracture healing score: excellent 19 cases good 3 cases middle 2 cases poor 0 cases. The excellent and good rate is 91.6%. Conclusion: VSD combined with open bone grafting or bone transfer is an effective method for the treatment of traumatic osteomyelitis of tibia with skin and soft tissue defect.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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