一期带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损

目的探讨一期带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损的方法及疗效。方法 2008年6月~2013年3月,收治小腿创伤后骨髓炎伴骨及软组织缺损患者36例。男25例,女11例;年龄22~60岁,平均46.5岁。病程1~5个月,平均2.5个月。软组织缺损面积为4 cm×5 cm~13cm×8 cm,骨缺损长度0.5 cm~2.5 cm,平均1.8 cm。采用带蒂组织瓣移位联合万古霉素骨水泥及颗粒骨植入一期治疗。选择带蒂的腓肠肌肌瓣16例,比目鱼肌肌瓣12例,腓肠神经营养血管肌皮瓣6例,远端蒂股前外侧肌皮瓣2例,同时一期联合万古霉素骨水泥填充及颗粒骨植骨,肌瓣表面游离植皮处理。结果 36例患者均获随访,随访时间24~55个月,平均39.5个月。2例组织瓣远端发生部分坏死,经清创换药及游离植皮后愈合,4例术后创面渗出患者经换药处理后愈合,2例感染未控制,经再次手术病灶清除及灌洗引流后愈合。所有骨折均骨性愈合,愈合时间6~21个月,平均12个月。末次随访时按Johner-Wruhs标准评定疗效,优20例,良12例,可4例,优良率为88.9%。结论一期应用带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损,有利于创面愈合、感染控制及骨缺损修复,可获得良好的临床疗效。

One-stage application of pedicle flap combined with vancomycin cement and granulated bone in treating post-traumatic osteomyelitis of lower leg with bone and soft tissue defect

Objective To explore the method and clinical effect of one-stage pedicle flap transfer combined with vancomycin cement and granulated bone implantation in treating post-traumatic osteomyelitis of lower leg with bone and soft tissue defect. Methods Between June 2008 and March 2013, 36 cases of post-traumatic osteomyelitis of lower leg with bone and soft tissue defect were treated with one-stage pedicle flap transfer combined with vancomycin cement and granulated bone implantation. There were 25 males and 11 females, with an average age of 46.5 years (from 22 to 60 years). The mean duration was 2.5 months (from 1 to 5 months). The area of soft tissue defect was from 4 cm * 5 cm to 13 cm * 8 cm, and the average bone defect length was 1.8 cm (from 0.5 to 2.5 cm). There were 16 cases underwent vascularised gastrocnemius muscle flap, 12 cases of soleus muscle flap, 6 cases of sural nerve nutrient vessels myocutaneous flap, 2 cases of distal femoral anterolateral myocutaneous flap, at one-stage combined with vancomycin cement and granulated bone implantation, and the surface of muscle flap was repaired by skin graft. Results Thirty-six cases were followed up for 24-55 months (mean, 39.5 months). Two cases suffered distal partial necrosis and healed after debridement dressing and free skin graft. Four cases of wound effusion healed by dressing. Two cases of recurrent infection healed after lesions cleared and lavage drainage. All fractures healed after 6-21 months (mean, 12 months). According to Johner-Wruhs standard assessment at the last follow-up, 20 cases were excellent, good in 12 cases, fair in 4 cases, and the excellent and good rate was 88.9%. Conclusion One-stage application of pedicle flap combined with vancomycin cement and granulated bone in treating post-traumatic osteomyelitis of lower leg with bone and soft tissue defect, is conducive to wound healing, infection control and bone defect repair, which can obtain good clinical curative effect.