胸骨正中切口术后胸骨骨髓炎外科治疗效果分析

目的探讨胸骨正中切口术后胸骨骨髓炎外科治疗方法及临床疗效。方法回顾分析2007年8月～2012年6月收治的15例胸骨正中切口术后胸骨骨髓炎患者临床资料,根据创面大小、感染范围及纵隔固定情况,选择清创后负压治疗、中厚皮片植皮及清创后肌皮瓣或大网膜转移修复治疗。结果无围手术期死亡者,1例清创后负压治疗后伤口愈合;l例植皮后局部坏死,再次植皮后愈合;12例肌皮瓣均成活良好,11例Ⅰ期愈合。随访8～26个月,切取腹直肌肌皮瓣者无切口疝发生,胸骨骨髓炎无复发,呼吸功能无明显影响,修复区形态尚满意。结论胸骨正中切口术后胸骨骨髓炎治疗棘手,临床应根据具体情况选择个体化外科治疗方法,可获满意效果。

Effect analysis on sternum osteomyelitis surgical treatment after median sternal incision surgery

Objective To discuss surgical treatment and its clinical effect of sternum osteomyelitis after median sternal incision surgery.Methods Retrospective analysis clinical data of 15 patients with sternum osteomyelit was treated by median sternal incision surgery from August 2007 to June 2012.Chose negative pressure treatment,mid-thick skin graft,myocutaneous flap or greater omentum metastasis restorative treatment after debridement with the patients on the bases of the size of wound,infection scope and the mediastinum fixed condition of the patients.Results There was no death case during the perioperative period;one case with wound healing after the negative pressure treatment,one case with local necrosis,and wound healing after skin-grafting once again,twelve cases with well musculocutaneous flap survival rate,and 11 cases of them found wound healing during Ⅰperiod.There wasn＇t found incisional hernia on patients who cut the rectus abdominis musculocutaneous flap,their sternum osteomyelitis no replase,there was no obvi ously impact on respiratory function,and form in repair area was satisfied after 8 to 26 months follow-up visit.Conclusion It is difficult to treat sternum osteomyelitis after median sternal incision surgery.If the Clinical want obtain a promising result they should choose a individualized surgical treatment in accordance with the specific condition.