【摘要】：目的:探討負壓封閉吸引(vacuum sealing drainage,VSD)聯(lián)合開放性植骨或骨搬移技術治療脛骨創(chuàng)傷性骨髓炎合并皮膚軟組織缺損的臨床療效。方法:回顧性分析2012年1月~2013年9月本院收治且獲得完整隨訪的24例脛骨創(chuàng)傷性骨髓炎患者的臨床資料,男16例,女8例;年齡22~61歲,平均41.5歲。術前均行創(chuàng)面細菌培養(yǎng)+藥敏試驗、X片及CT三維重建檢查。清創(chuàng)后脛骨缺損長度2~9cm,平均(5.96±2.14)cm;創(chuàng)面范圍為3cm×3 cm~9 cm×7 cm,平均(25.63±17.44)cm2。對5例骨缺損"f4cm病例采用清創(chuàng)、VSD(負壓封閉吸引)、開放性植骨治療;對19例骨缺損4cm病例采用清創(chuàng)、VSD、骨搬移治療。結(jié)果:24例患者獲隨訪10~18個月,平均13.3個月。24例患者抗生素使用天數(shù)5-14天,平均7.9天。VSD治療0~10次,平均2.9次。2例患者創(chuàng)面清創(chuàng)后可直接縫合,其余22例患者創(chuàng)面均愈合。19例患者骨端自然愈合,愈合時間4~15月,平均6.4月;5例患者采用骨搬移治療后出現(xiàn)斷端骨不連,通過清理骨端皮膚及軟組織嵌頓、打通骨髓腔、自體髂骨植骨及VSD治療后達到骨端愈合。2例患者治療期間出現(xiàn)釘?shù)栏腥?應用抗生素治療后感染控制,其余患者無感染復發(fā)。術后1、2個月隨訪軟組織缺損面積均較術中顯著改善,差異有統(tǒng)計學意義(P0.05);按Paley骨折愈合評分標準:優(yōu)19例,良3例,中2例,差0例。優(yōu)良率為91.6%。結(jié)論:VSD聯(lián)合開放性植骨或骨搬移技術是治療脛骨創(chuàng)傷性骨髓炎合并皮膚軟組織缺損的有效方法。
[Abstract]:Objective: to investigate the clinical effect of (vacuum sealing drainage,VSD combined with open bone grafting or bone transfer in the treatment of traumatic osteomyelitis of tibia with skin and soft tissue defect. Methods: the clinical data of 24 patients with traumatic osteomyelitis of tibia treated in our hospital from January 2012 to September 2013 were analyzed retrospectively, including 16 males and 8 females, aged 2261 years with an average of 41.5 years. The bacterial culture sensitivity test, X-ray and three-dimensional CT reconstruction were performed before operation. After debridement, the length of tibial defect was 2? 9 cm, with an average of (5. 96 鹵2. 14) cm; wound area of 3cm 脳 3 cm~9 cm 脳 7 cm, and an average of (25.63 鹵17. 44) cm2.? Five cases of f4cm with bone defect were treated by debridement of, VSD (negative pressure and suction), and 19 cases of 4cm with bone defect were treated with debridement and VSD, bone transfer. Results: 24 patients were followed-up for 10 ~ 18 months (mean 13.3 months), 24 patients were treated with antibiotics for 5-14 days (average 7.9 days), VSD was used for 10 times (average 2. 9 times), and 2 cases were treated with direct suture after debridement. 19 cases healed naturally, the healing time was 4 ~ 15 months (mean 6.4 months). Bone nonunion was found in 5 patients after bone transfer. Bone marrow cavity was opened by clearing the skin and soft tissue incarceration of bone end, autogenous iliac bone graft and VSD treatment were used to achieve bone end healing, 2 patients developed nail infection during treatment. Infection was controlled after antibiotic therapy, and no infection recurred in other patients. The area of soft tissue defect was significantly improved at 1 and 2 months after operation (P0.05). According to Paley fracture healing score: excellent 19 cases good 3 cases middle 2 cases poor 0 cases. The excellent and good rate is 91.6%. Conclusion: VSD combined with open bone grafting or bone transfer is an effective method for the treatment of traumatic osteomyelitis of tibia with skin and soft tissue defect.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

【參考文獻】

相關期刊論文 前5條

1 樊建新;許景紅;王東學;毛成鵬;;吻合血管蒂游離腓骨肌皮瓣移植并植骨治療脛骨骨髓炎骨缺損[J];中國骨與關節(jié)損傷雜志;2013年12期

2 李維;王子明;杜全印;王雨;熊雁;王愛民;;骨搬移技術治療下肢感染性骨缺損[J];第三軍醫(yī)大學學報;2015年03期

3 余黎;余國榮;蔡林;喻愛喜;陶圣祥;金偉;潘振宇;鄧凱;胡昊;;KW組合式外固定骨延長器在下肢截骨延長及骨遷移中的應用[J];中國矯形外科雜志;2011年23期

4 沈立鋒;郭峭峰;黃凱;張展;張曉文;張春;;帶蒂組織瓣結(jié)合骨搬移技術治療小腿感染性軟組織缺損及大段骨缺損[J];中華移植雜志(電子版);2012年04期

5 郝光亮;張貴春;曹學成;;骨搬移術治療脛骨骨折術后感染性大段骨缺損的療效分析[J];中國骨與關節(jié)外科;2014年05期

，

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