负压封闭引流联合筋膜皮瓣转移分期手术治疗创伤后骨髓炎

目的:探讨应用负压封闭引流技术(VSD)及筋膜皮瓣转移分期手术治疗伴有皮肤缺损创伤后骨髓炎的疗效。方法:自2007年12月至2009年12月,应用负压VSD及筋膜皮瓣转移分期手术治疗创伤后骨髓炎14例,男9例,女5例;年龄20～63岁,平均36岁;所有患者均为创伤术后感染。受伤部位:胫骨9例,跟骨3例,股骨1例,尺桡骨1例。感染时间2～96周,平均32周。结果:所有患者获得随访,时间12～36个月,平均19.2个月。使用VSD清创1～3次,平均1.57次。13例患者创面伤口Ⅰ期愈合,1例有渗出,经引流换药,术后3周愈合。8例患者因骨缺损及骨折延迟愈合,Ⅱ期行自体植骨术,术后1年随访骨折均愈合,术后感染未复发。结论:负压封闭引流技术联合筋膜皮瓣转移治疗创伤术后骨髓炎能够发挥负压封闭引流技术和皮瓣转移技术的优点,缩短治疗时间,安全性及可靠性较好,是一种有效的治疗方法。

VSD combined with fascio-cutaneous flap transferation staging operation to treat post-traumatic osteomyelitis

Objective: To explore the therapeutic effects of VSD combined with fascio-cutaneous flap transferation staging operation for the treatment of post-traumatic osteomyelitis. Methods: From December 2007 to December 2009,14 patients were treated with the technology of VSD combined with fascio-cutaneous flap transferation staging operatinon. Nine patients were males and 5 patients were females,and mean age was 36 years. All the patients were postoperative wound infection. Osteomyelitis of the tibia was in 9 cases,calcaneus in 3 cases,femur in 1 case,radius and ulna in 1 case; infection of time were from 2 to 96 weeks,an average time of 32 weeks. Results: All the patients were followed up,and the duration ranged from 12 to 36 months,with an average of 19.2 months. All the patients were treated with debridement and VSD for 1 to 3 times,with an average of 1.57 times. The wounds of 13 cases healed well after flaps transferation,but of 1 case leakaged and healed after 3 weeks with the therapy of drainaging and changing dressings. Due to delayed healing or defects of bone,8 patients had autologous bone grafted on the second stage. All wounds and fractures healed without recurrence of postoperative infection. Conclusion: VSD combined with flap transferation is an effective treatment of post-traumatic osteomyelitis,which can shorten the treatment time and have better security and reliability than traditional methods.