慢性骨髓炎的治疗

目的:介绍慢性骨髓炎的治疗经验。方法:术前停用一切抗生素2周,有窦道或创面者连续3天行分泌物细菌培养及药敏试验。术中取髓腔内脓液、炎性肉芽组织或死骨再次送培养,然后彻底清创,清除失去活力的一切组织。若脓液较多,行滴注引流2～4周。脓液较少骨量不足者,1期植骨,否则3～6个月后2期植骨。再依软组织缺损情况,采用局部皮瓣或肌瓣转移修复。结果:68例患者均获治愈,行皮瓣修复者全部成活;植骨者全部愈合,愈合时间6～12个月。随访6个月～16年,无1例复发,皮瓣质地好、功能佳、外形满意。结论:彻底清创、依细菌培养结果选择敏感抗生素、恰当选择植骨时机并及时以皮瓣或肌瓣覆盖创面改善局部血运,是根治慢性骨髓炎的关键。

Treatment of Chronic Osteomyelitis

Objective:To introduce an experience of chronic osteomyelitis.Methods:To stop using any antibiotics pre-operatively for 2 weeks,and germiculture of secretion and drug sensitive test successively were done to those sinus tracts or wounds for 3 days.The medullary pus,inflammatory granulation tissue and necrotic bone were taken to get cultured again,and was debrided and removed any devitalized tissue.More pus was performed with instillation and drainage 2-4 weeks while less pus and insufficient bone with bone graft at one-stage otherwise secondarily after 3-6 months.And then the local flap or muscle flap was harvested to repair the defect,depending on the size of soft-tissue defect of recipient wound.Results:By this way,we treated 68 patients.All the cases with flaps harvesting and bone grafting were uneventful postoperatively.All the patients were followed up for 6 months ～ 16 years,and the quality of the flaps were good and the appearance of the flaps were satisfactory.No case reoccurred.Conclusion:Thorough debridement,sensitive antibiotics choosing according to germiculture,opportunity of bone graft to be selected appropriately and recovery of skin defect by flap or muscle flap transfer to improve the local blood supply are the key to heal the osteomyelitis.