摘要
目的探讨采用股前外侧嵌合穿支皮瓣联合载万古霉素硫酸钙治疗伴有软组织缺损的小腿骨折内固定术后慢性感染的疗效。方法回顾性分析2008年9月到2020年11月北京大学深圳医院骨关节科收治的16例小腿骨折内固定术后慢性感染合并广泛软组织缺损患者资料。男11例,女5例;年龄16~62岁,平均37岁;感染部位:胫骨上段4例,胫骨中下段10例,腓骨中段2例;按Cierny-Mader分型:所有患者解剖分型均为Ⅲ型,宿主分型:B型14例,C型2例。软组织缺损面积6 cm×4 cm~23 cm×14 cm。所有患者均接受股前外侧嵌合穿支皮瓣移植术联合载万古霉素硫酸钙治疗。末次随访时按Paley等骨折愈合评分标准评定疗效。结果所有患者术后随访8~24个月(平均16个月)。15例皮瓣全部成活,1例皮瓣部分存活。末次随访时按Paley等骨折愈合评分标准评定疗效:优15例,良1例。移植人工骨与胫腓骨均在术后6~l2个月(平均8.9个月)内获骨性愈合。1例于术后1年复发,出现慢性窦道流脓,经再次清创,感染控制,伤口愈合。14例患者更换了单边或环形外固定支架,2例保留钢板内固定。骨缺损长度平均2.4 cm,外固定支架使用时间8~14个月(平均10.5个月)。结论股前外侧嵌合穿支皮瓣联合载万古霉素硫酸钙治疗伴广泛软组织缺损的小腿骨折内固定术后慢性感染疗效满意,能充分覆盖骨及软组织缺损,有效控制感染。
Objective To investigate the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate in the treatment of chronic infection after internal fixation of calf fracture with soft tissue defects.Methods Retrospectively analyzed were the data of 16 patients with chronic infection combined with extensive soft tissue defects after internal fixation of calf fracture who had been admitted to Department of Orthopedics,Shenzhen Hospital Affiliated to Peking University from September 2008 to November 2020.There were 11 males and 5 females,aged from 16 to 62 years(average,37 years).Infection sites:the upper tibia in 4 cases,the middle and lower tibia in 10 cases,and the middle fibula in 2 cases.According to the Cierny-Mader classification,all patients were anatomical type III and by the host classification,there were 14 cases of type B and 2 cases of type C type.The areas of soft tissue defects ranged from 6 cm×4 cm to 23 cm×14 cm.All patients were treated by transplantation of an anterolateral thigh chimeric perforator flap combined with vancomycin-loaded calcium sulfate therapy.At the last follow-up,the curative efficacy was evaluated according to the Paley fracture union scoring.Results All patients were followed up for 8 to 24 months(mean,16 months).Complete flap survival was achieved in 15 flaps and partial survival in one.According to the Paley fracture union scoring at the last follow-up,the curative efficacy was evaluated as excellent in 15 cases and as good in one.Both the grafted artificial bone and the tibia and fibula achieved bone union after 6 to 12 months(mean,8.9 months).Infection with chronic sinus tract pus recurred in one case at post-operative one year.After re-debridement,the infection was controlled and the wound healed.The plate internal fixation was replaced by the unilateral or annular external fixator in 14 patients and retained in 2 patients.The lengths of the bone defects averaged 2.4 cm and the time for the external fixation 10.5 months(from 8 to 14 months).Conclusion In the treatment of chronic infection after internal fixation of calf fracture with extensive soft tissue defects,the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate is satisfactory,because the flap can fully cover the bone and soft tissue defects while the vancomycin-loaded calcium sulfate can effectively control the infection.
作者
周喆刚
曾晖
万圣祥
肖颖锋
张建
孟繁斌
褚云峰
于龙彪
Zhou Zhegang;Zeng Hui;Wan Shengxiang;Xiao Yingfeng;Zhang Jian;Meng Fanbin;Chu Yunfeng;Yu Longbiao(Shantou University Medical College,Shantou 515041,China;Department of Orthopaedics,Peking University Shenzhen Hospital,Shenzhen 518036,China;Department of Hand Microsurgery,Peking University Shenzhen Hospital,Shenzhen 518036,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第10期905-909,共5页
Chinese Journal of Orthopaedic Trauma
关键词
骨疾病
感染性
外科皮瓣
硫酸钙
万古霉素
软组织缺损
Bone diseases,infectious
Surgical flaps
Calcium sulfate
Vancomycin
Defects of bone and soft tissue
