负压吸引技术结合万古霉素全身应用治疗胫骨慢性骨髓炎

目的探讨采用负压吸引技术结合万古霉素全身应用治疗胫骨慢性骨髓炎的疗效。方法回顾性分析本院采用负压吸引技术结合万古霉素全身应用治疗137例胫骨慢性骨髓炎,创伤后人工内固定感染114例,血源性感染23例。彻底清创后采用密闭负压封闭吸引关闭创面,术后持续应用万古霉素4~6周。结果 129例患者获得平均25个月(17~44个月)随访,共13例复发,复发时间为术后2~7个月。结论采用负压吸引技术结合万古霉素全身应用治疗胫骨慢性骨髓炎可明显提高手术治愈率,改善局部成骨条件。     

负压封闭引流技术在骨筋膜室综合征中的应用

目的探讨负压封闭引流技术(Vacuum Sealing Drainage,VSD)在骨筋膜综合征中的应用及其临床效果。方法对11例骨筋膜室综合征患者的18处减张切口采用VSD材料一期覆盖,通过持续负压吸引以及更换VSD材料,使创面能直接拉拢缝合。减张切口位于前臂掌侧以及小腿内外侧,减张后创面面积为26cm×10cm～12cm×6cm。结果 18处创面均直接缝合,11处创面通过1次负压吸引后闭合,5处创面通过2次负压吸引后闭合,2处创面通过3次负压吸引后闭合,负压吸引时间为7～21d,平均13d。1例创面发生感染,经清创及更换VSD材料治疗后愈合。随访3～6个月,切口瘢痕柔软,无肌肉挛缩等并发症。结论负压封闭引流技术可以有效地闭合深筋膜减张切口,操作简便,创面愈合良好。     

负压封闭引流技术与传统灌注冲洗术治疗下肢难治性骨感染的疗效比较

目的 比较负压封闭引流(VSD)技术与传统灌注冲洗术治疗下肢难治性骨感染的疗效. 方法 对2007年2月至2010年10月收治的72例难治性骨感染患者资料进行回顾性分析,根据治疗方法不同分为VSD组(应用VSD技术治疗)和传统组(应用传统灌注冲洗术治疗).VSD组38例,男21例,女17例;年龄22 ～ 61岁,平均(45.4±3.1)岁.传统组34例,男22例,女12例;年龄29 ～ 65岁,平均(46.5±2.2)岁.所有患者在创面闭合前复查血常规、血沉、C-反应蛋白,并行细菌培养.两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.比较两组患者的感染控制时间、创面闭合时间、住院时间、换药次数和复发率. 结果 VSD组38例患者术后获10 ～ 14个月(平均12个月)随访,传统组34例患者术后获12～ 16个月(平均13.8个月)随访.所有患者创面均愈合良好、颜色正常,细菌培养均为阴性,肢体功能恢复良好.VSD组感染控制时间平均为(2.8±0.8)周、创面闭合时间平均为(8.2±1.3)d、住院时间平均为(15.5±2.1)d、换药次数平均为(3.8±2.2)次、复发率为2.63％,明显优于传统组[(4.6±0.5)周、(19.5±5.7)d、(27.6±2.8)d、(13.5±1.7)次、20.59％],差异均有统计学意义(P＜0.05).结论 与传统灌注冲洗术比较,VSD技术治疗下肢难治性骨感染在感染控制时间、创面闭合时间、住院时间、换药次数及复发率方面均有明显优势.     

VSD结合Papineau技术治疗创伤后慢性骨髓炎

目的 探讨VSD结合Papineau技术治疗创伤骨折内固定术后感染所致慢性骨髓炎的临床疗效。方法 对本院2008年1月至2013年6月,收治的18例骨折内固定术后感染所致的骨外露、骨缺损患者,多次清创和负压封闭引流(Vacuum sealing drainage,VSD)治疗,待创面肉芽组织生长良好后采用Papineau技术开放肉芽创面植骨,Ⅱ期植皮或直接缝合闭合创面。结果 18例均获随访,随访时间11~21月,平均16月。18例感染控制骨折愈合,无感染复发病例。结论 VSD结合Papineau技术能有效控制感染,消灭骨死腔促进骨愈合,对骨折内固定术后感染所致的慢性骨髓炎及骨缺损具有重要的临床意义。     

拉杆式伤口皮肤扩展器联合封闭负压引流术在小腿慢性创面缺损修复中的应用

目的探讨拉杆式伤口皮肤扩展器(Skin stretching device, SSD)联合封闭负压引流技术(Vacuum Sealing Drainage, VSD)在小腿慢性创面缺损修复中的应用及疗效。方法 2017年10月-2018年4月收治小腿慢性创面缺损5例,应用拉杆式伤口皮肤扩展器联合封闭负压引流技术治疗,并观察其术后疗效。结果 5例中3例应用拉杆式伤口皮肤扩展器直接闭合,2例创面较大,无法直接闭合,拉拢皮肤后配合植皮修复创面。5例术后均无感染,术后随访6～18个月,患肢皮肤未形成瘢痕挛缩,相邻关节活动未见受限。结论拉杆式伤口皮肤扩展器联合封闭负压引流技术治疗小腿慢性创面缺损疗效良好,值得临床推广。     

改进新型负压封闭吸引技术治疗慢性软组织缺损创面

目的:探讨改进新型负压封闭吸引技术用以治疗慢性创面的临床效果。方法:将患者随机分为实验组和对照组,其中实验组采用改进的新型负压封闭治疗,对照组采用传统换药治疗。分别记录两组患者创面有无感染、疼痛目测类比(VAS)评分,创面的愈合时间,并记录相关数据并进行统计学分析。结果:实验组14例慢性创面愈合良好,随访6~12个月创面无破溃、感染等并发症,愈合时间较传统换药时间显著缩短,愈合质量提高,治疗经费较使用商品负压封闭引流技术(vacuum sealing drainage,VSD)材料大幅降低,患者对治疗效果满意。术后随访0.5~1年,无明显并发症。结论:改进新型负压封闭引流技术治疗慢性软组织创面效果满意,使用材料简单,容易操作,安全性高,设备技术要求不高,创面愈合时间大大缩短,治疗费用大幅下降,值得临床推广。     

负压封闭引流在感染创面的局部应用

目的:评估负压封闭引流术(VSD)在感染创面局部应用的效果.方法:挑选18名创面感染患者,平均年龄(45±10)岁,其中11名男性,7名女性,感染创面部位:手部8例,小腿5例,臀部3例,骶部2例,创面使用100～125mmHg负压持续吸引2天,然后间歇吸引,平均负压吸引时间为(9±2)天,测量VSD治疗前后创面大小,随访平均时间为(11±6)个月.结果:创面平均吸引出100±50ml液体,组织水肿及创面引流得到解决,创面清洁干燥,其中15例患者通过运用抗生素及负压吸引术,创面已达到临床愈合,细菌培养阴性,通过负压治疗创面大小从(28±9)cm2减少至(12±8)cm2(P<0.05),只有6例需要进一步外科干预达到闭合创面,2例患者使用负压吸引后感觉疼痛.结论:与传统治疗方法相比,除了VSD本身对创面快速愈合的优点外,还提供了一个快速、舒适的条件.     

抗生素骨水泥链珠结合负压封闭引流技术在感染创面治疗中的应用

目的探讨抗生素骨水泥链珠结合负压封闭引流技术治疗感染创面的临床效果。方法选取自2014年7月至2017年7月收治的感染创面患者50例,随机分为对照组与实验组,每组25例。对照组单纯使用负压封闭引流方法治疗;实验组使用抗生素骨水泥链珠结合负压封闭引流技术对感染创面进行治疗。术后通过对负压封闭更换次数、创面愈合时间、感染复发情况、组织愈合情况等观察,比较两种方法的治疗效果。结果治疗后所有患者的创面均得到良好愈合,随访6~36个月,无感染复发。其中,对照组平均负压封闭引流更换次数为(3.68±0.56)次,显著多于实验组平均更换次数(2.52±0.28)次,其组间比较差异具有统计学意义(P0.05);对照组创面愈合时间为(32.35±2.76)d,长于实验组的愈合时间(27.58±3.57)d,其组间比较差异具有统计学意义(P0.05)。结论抗生素骨水泥链珠结合负压封闭引流技术填充创面可以很好地治疗感染性创面,缩短治疗时间,值得临床推广应用。     

显微外科手术配合负压封闭吸引治疗慢性骨髓炎16例

目的 探讨显微外科手术配合负压封闭吸引(VSD)配合持续冲洗治疗慢性骨髓炎的临床效果.方法 对16例慢性骨髓炎进行彻底病灶清理后采用VSD配合持续冲洗治疗,治疗8～18 d后手术闭合创面.结果 VSD配合持续冲洗治疗后慢性骨髓炎创面肉芽组织新鲜、感染控制,直接缝合或皮瓣修复后,创面均一期愈合.随访6～36个月,未出现感染复发.结论 显微外科手术联合VSD配合持续冲洗是治疗慢性骨髓炎的一种有效方法.     

负压封闭引流技术辅助组织瓣修复复杂或慢性创面

目的观察负压封闭引流技术应用于术前准备阶段协助组织瓣修复复杂或慢性创面的作用。方法回顾分析近2年来用此方案治疗的8例复杂或慢性创面患者．入院时均存在不同程度的创面血运差、骨或其他深部组织外露和顽固感染,一期先行清创手术后使用VSD持续负压吸引创面治疗,待创面新鲜无感染、肉芽丰富后,二期行组织瓣（包括带蒂组织瓣和游离组织瓣）移植覆盖创面。结果应用VSD技术可有效控制创面感染,促进肉芽组织生长。移植皮瓣全部成活,随访3-16个月,无慢性感染、溃疡和窦道存在,效果满意。结论术前正确应用VSD技术,可使创面准备相对简便和快捷．可有效地协助组织瓣修复复杂或慢性创面．值得临床推广和进一步深入研究。     

Successful truncated osteomyelitis treatment for chronic osteomyelitis secondary to pressure ulcers in spinal cord injury patients

Time-tested treatments for chronic osteomyelitis involve prolonged courses of costly antibiotic treatment. Although such treatment remains unquestioned in acute osteomyelitis, it is an excessive regiment for chronic osteomyelitis. With appropriate surgical debridement and careful operative care, antibiotic treatment can be truncated in diagnoses of chronic osteomyelitis. This study represents the clinical practice of the pressure ulcer management program at Rancho Los Amigos National Rehabilitation Center in dealing with this difficult problem. One hundred fifty-seven patients with similar pressure ulcer wounds were studied retrospectively. Three groups of patients with pathologic diagnoses of acute osteomyelitis, chronic osteomyelitis, and negative osteomyelitis were compared for (1) postoperative stay, (2) wound infection, (3) wound breakdown requiring reoperation, and (4) same-site ulcer recurrence. In all cases, shallow bone shavings were sent for diagnosis via histologic study, and deep shavings were also sent to ensure adequate bone debridement and microbiologic study. All ulcers were subsequently closed with muscle and/or myocutaneous flaps. The negative and chronic osteomyelitis groups were treated with 5 to 7 days of IV antibiotics, whereas the acute group underwent a full 6-week course according to bone bacteriological culture and sensitivity. There was no statistical difference between the chronic osteomyelitis group and the control (negative) osteomyelitis group with respect to postoperative stay (70 days for chronic group, 72.4 for control), wound breakdown rate (10.7% for chronic, 10.2% for control), or ulcer recurrence (1.8% for chronic, 4.1 for control). The acute osteomyelitis group incurred longer hospital stays, greater incidence of wound breakdown, and statistically significantly greater ulcer recurrence (78.6 days, 13.2% and 17.0%, respectively). In cases of pressure ulcer management with bony involvement, bone pathologic diagnosis of chronic osteomyelitis allows for a shorter antibiotic course with better results when the offending tissue has been adequately debrided and closed with viable tissue flap coverage, than simple long-term (4-6 weeks) antibiotic treatment. Because of the extreme contaminated nature of these wounds, if such therapy works in these patients, it may be applicable to chronic osteomyelitis in more varied contaminated surgical cases involving bone.     

多网管解剖型置管灌洗法治疗骨折术后继发慢性骨髓炎

 目的探讨多网管解剖型置管灌洗法在骨折术后继发慢性骨髓炎治疗中的应用价值。方法回顾性分析 2006年 6月至 2008年 12月收治的骨折术后继发慢性骨髓炎患者 40例(41处)的病例资料.男 35例.女 5例;年龄 16~68岁.平均 42.7岁。对 40例(41处)采用彻底清创、闭合死腔、多网管解剖型置管灌洗引流、全身及局部应用敏感抗生素等系列疗法治疗 3~4周。术后每 3个月复查.包括切口愈合情况、X线片表现、红细胞沉降率和 C-反应蛋白。按灌洗治疗结束时炎症是否稳定及术后 6个月时炎症是否复发制定疗效评价标准.参考指标包括伤口愈合情况、全身症状、红细胞沉降率及 C-反应蛋白等。结果 按上述疗效判定标准.优 37例.切口一期愈合.术后 6个月时无复发;良 2例.切口愈合稍差.经换药治疗后愈合.术后 6个月时无复发;差 1例.窦道复发.切口未愈。 36例在术后半年行植骨内固定术.术后骨折愈合.4例未经植骨直接愈合。随访 30~50个月.平均 43.2个月.均无复发。结论多网管解剖型置管灌洗法对于骨折术后继发慢性骨髓炎的治愈率高.可操作性强.术后好管理.是一种有效的治疗方法。     

负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎的临床研究

目的 :研究负压封闭引流联合负载万古霉素硫酸钙与自体骨在治疗慢性骨髓炎中的疗效。方法 :2013年6月至2016年12月治疗35例慢性骨髓炎患者,男23例,女12例;年龄11~65岁,平均34岁;病程8~46个月,平均26个月。所有患者为开放性创伤导致的慢性骨髓炎,病灶局部有反复红肿及脓液穿破皮肤病史。32例窦道分泌物细菌培养阳性,3例窦道分泌物细菌培养阴性。影像学检查显示病灶存在骨破坏、骨缺损,周围有骨质增生硬化。Ⅰ期行彻底清创,清除病灶坏死及炎性组织,负压封闭引流敷料完全覆盖创面,以促进创面的修复。Ⅱ期将负载万古霉素硫酸钙与自体髂骨松质骨混合为移植骨复合体,均匀填充病灶。观察患者伤口愈合情况,并对病灶进行X线检查,了解硫酸钙吸收及新骨生长情况。结果:26例行1次清创加负压封闭引流,6例行2次清创加负压封闭引流,3例行3次清创加负压封闭引流。32例伤口甲类愈合,2例乙类愈合的患者经抗感染、伤口换药等治疗后伤口完全愈合。1例丙类愈合的患者于术后4周时再行清创,伤口正常愈合。所有患者病灶处未再次出现皮肤红肿及破溃,X线片显示植入的硫酸钙4周左右开始逐步吸收,8周左右有新骨生成,6~24个月病灶区骨缺损完全愈合。结论:负压封闭引流联合负载万古霉素硫酸钙与自体骨治疗慢性骨髓炎,临床疗效良好、可靠,值得临床推广。     

Coverage of the infected wound.

Fifty-four consecutive patients with chronic wounds were identified by the following criteria: (1) established infection for 6 months, (2) exposure of bone, mediastinum, or other vital structure, (3) mechanical and/or vascular limitations to delayed closure techniques, (4) no response to wound debridement in prolonged antibiotic therapy. These wounds were divided into four groups: osteomyelitis (21), pressure sore (17), soft tissue wound (10), and osteoradionecrosis (6). Wound treatment in all patients included debridement, muscle flap closure, and culture specific antibiotic therapy. These consecutively treated patients over a 4-year period presented with an average duration of chronic infection of 2.9 years. Ninety-three per cent of these patients after treatment have demonstrated stable coverage without recurrent infection with a minimum of 1 year and a maximum of 4.6 years follow-up. The results demonstrate safe, effective coverage (93% of patients) of chronic infected wounds associated with long bone and pelvic osteomyelitis as well as chronic perineal sinuses following proctocolectomy and osteoradionecrosis. Debridement with short-term (average 12 days) antibiotic therapy has been effective when muscle flap coverage is provided.     

Treatment of Chronic Osteomyelitis: A Prospective Study of 55 Cases Treated with Radical Surgery and Primary Wound Closure

A prospective and consecutive series of 55 patients were treated for chronic osteomyelitis occurring mainly in the lower extremity and after fractures treated with internal fixation. The mean duration of osteomyelitis was 27 months. Sixty- five per cent had previously undergone operations and had been hospitalized for an average of 131 days. Staphylococcus aureus was cultured in 72 per cent of the cases as the solitary agent. In 6 cases no bacteria were found. The remaining cases had more than one species. The treatment consisted of radical operation, removal of all internal fixation, sequestrectomy, partial decortication and primary wound closure with suction drainage. External fixation was used for bone stabilization. In 13 cases plastic procedures were carried out. Antibiotics appropriate for the sensitivity patterns were given for a maximum of 3 months. Primary wound healing was obtained in 98 per cent of the cases. In practically all cases the sedimentation rate normalized within 4 weeks after the operation. The results in the available literature indicate that radical operation is effective in the treatment of osteomyelitis and this treatment seems economical as regards hospitalization time and quantity of antibiotics required     

Chronic osteomyelitis after sternotomy

Two patients with chronic sternal osteomyelitis after an initially uncomplicated coronary artery bypass grafting (CABG) operation are described. Chronic osteomyelitis, caused in both cases by Pseudomonas aeruginosa, occurred six and four months after CABG respectively. Because chronic infection failed to respond to local wound care and medical therapy, more radical treatment was needed. Steel wires were removed and surgical debridement was performed. In one patient, an additional omental transposition was performed. In both cases radical debridement in combination with antibiotics successfully eradicated the infection.     

Treatment of Chronic Osteomyelitis: A Prospective Study of 55 Cases Treated with Radical Surgery and Primary Wound Closure

A prospective and consecutive series of 55 patients were treated for chronic osteomyelitis occurring mainly in the lower extremity and after fractures treated with internal fixation. The mean duration of osteomyelitis was 27 months. Sixty- five per cent had previously undergone operations and had been hospitalized for an average of 131 days. Staphylococcus aureus was cultured in 72 per cent of the cases as the solitary agent. In 6 cases no bacteria were found. The remaining cases had more than one species. The treatment consisted of radical operation, removal of all internal fixation, sequestrectomy, partial decortication and primary wound closure with suction drainage. External fixation was used for bone stabilization. In 13 cases plastic procedures were carried out. Antibiotics appropriate for the sensitivity patterns were given for a maximum of 3 months. Primary wound healing was obtained in 98 per cent of the cases. In practically all cases the sedimentation rate normalized within 4 weeks after the operation. The results in the available literature indicate that radical operation is effective in the treatment of osteomyelitis and this treatment seems economical as regards hospitalization time and quantity of antibiotics required     

Treatment of chronic osteomyelitis; a prospective study of 55 cases treated with radical surgery and primary wound closure

A prospective and consecutive series of 55 patients were treated for chronic osteomyelitis occurring mainly in the lower extremity and after fractures treated with internal fixation. The mean duration of osteomyelitis was 27 months. Sixty-five per cent had previously undergone operations and had been hospitalized for an average of 131 days. Staphylococcus aureus was cultured in 72 per cent of the cases as the solitary agent. In 6 cases no bacteria were found. The remaining cases had more than one species. The treatment consisted of radical operation, removal of all internal fixation, sequestrectomy, partial decortication and primary wound closure with suction drainage. External fixation was used for bone stabilization. In 13 cases plastic procedures were carried out. Antibiotics appropriate for the sensitivity patterns were given for a maximum of 3 months. Primary wound healing was obtained in 98 per cent of the cases. In practically all cases the sedimentation rate normalized within 4 weeks after the operation. The results in the available literature indicate that radical operation is effective in the treatment of osteomyelitis and this treatment seems economical as regards hospitalization time and quantity of antibiotics required.     

Wundunterdrucktherapie bei Schwerbrandverletzten

Negative pressure wound therapy has been used for many years for surgical, traumatic and chronic lesions. During the last 3 years negative pressure wound therapy was consistently pursued as a concept in adults with severe burn injuries in the burn center at the trauma center in Murnau. A total of 48 patients with severe burn injuries to a total body surface area (TBSA) of up to 90% were treated with negative pressure wound therapy. This therapy was used during all stages of treatment from the initial phases of debridement to split thickness skin grafting after debridement. Intensive care parameters and surgical parameters of tissue repair were recorded during the whole intensive care phase. These parameters were compared to data of burn patients who received conservative therapy. All patients with severe burn injuries treated with negative pressure wound therapy showed a significant reduction in redressing. Furthermore, outstanding wound conditioning and excellent take rates after split thickness skin grafting were observed. Intensive care parameters and surgical parameters of wound healing showed patients treated with negative pressure wound therapy were more stable in comparison to patients treated conservatively. Negative pressure wound therapy was shown to be an excellent option especially in the treatment of severe burn patients from initial debridement to final split skin grafting.     

应用股前外侧游离皮瓣移植治疗胫骨慢性骨髓炎的临床疗效观察

目的探讨应用股前外侧游离皮瓣移植治疗胫骨慢性骨髓炎的临床疗效。方法回顾分析2016年1月至2018年12月北京积水潭医院烧伤科应用股前外侧游离皮瓣移植治疗的13例胫骨慢性骨髓炎患者的临床资料。其中男10例,女3例;年龄18~43岁,平均34.3岁。13例患者经彻底清创后胫骨病灶处均形成骨外露创面,伴有皮肤缺损。应用股前外侧游离皮瓣填充清创后形成的空腔,对病灶进行修复治疗。结果 13例患者皮瓣完全成活,切口均Ⅰ期愈合。随访12个月,未见骨髓炎复发。结论应用股前外侧游离皮瓣移植治疗胫骨慢性骨髓炎的临床效果较好。