中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (48): 7797-7803.doi: 10.3969/j.issn.2095-4344.2014.48.016

• 骨科植入物 orthopedic implant • 上一篇    下一篇

外固定架与负压封闭引流及带蒂背阔肌皮瓣移植修复肱骨远端创伤性骨髓炎

沈美华，艾合买提江•玉树甫，任  鹏，刘亚飞   

  1. 新疆医科大学第一附属医院显微修复外科，新疆维吾尔自治区乌鲁木齐市  830054
  • 收稿日期:2014-09-22 出版日期:2014-11-26 发布日期:2014-11-26
  • 通讯作者: 艾合买提江?玉树甫，博士，主任医师，新疆医科大学第一附属医院显微修复外科，新疆维吾尔自治区乌鲁木齐市 830054
  • 作者简介:沈美华，女，1977年生，江苏省海门市人，汉族，新疆医科大学在读硕士，主治医师，主要从事数字骨科、创伤修复研究。
  • 基金资助:

    2013年国家自然科学基金项目(81360270)

Combination therapy of external fixator, vacuum sealing drainage and pediculated latissimus dorsi myocutaneous flap transplantation for distal humeral traumatic osteomyelitis

Shen Mei-hua, Aihemaitijiang•Yu-shu-fu, Ren Peng, Liu Ya-fei   

  1. Department of Microsurgery Repair, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2014-09-22 Online:2014-11-26 Published:2014-11-26
  • Contact: Aihemaitijiang?Yu-shu-fu, M.D., Chief physician, Department of Microsurgery Repair, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • About author:Shen Mei-hua, Studying for master’s degree, Attending physician, Department of Microsurgery Repair, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81360270

PDF

436

被引次数

34

摘要：

背景：骨髓炎的治疗属世界性难题，如何提高骨髓炎的治愈率是目前研究的重点。
目的：探讨外固定架联合负压封闭引流及带蒂背阔肌肌皮瓣移植对肱骨远端创伤性骨髓炎的修复效果。
方法：纳入2006年5月至2013年9月收治的所有明确诊断为肱骨远端创伤性骨髓炎的患者36例，采用外固定架、负压封闭引流、带蒂背阔肌肌皮瓣移植等方法联合治疗，通过Mayo肘关节评分系统评价治疗前、治疗后肘关节功能，采取门诊就诊、电话追踪和家庭访视等方式随访。
结果与结论：36例患者全部获得随访，随访时间8个月-6年8个月。带蒂背阔肌肌皮瓣全部存活，其中最大面积为40 cm×13 cm，最小为15 cm×6 cm。Orthofix外固定架治疗21例，组合式外固定架11例，Ilizarov环形外固定架4例，骨折愈合时间分别为6-14个月，10-16个月，8-20个月。外固定架取出时间平均8个月。治疗后肘关节功能优3例，良19例，中11例，差3例。其中2例感染复发；1例治疗后3个月窦道形成，行再次清创髂骨植骨后治愈；1例合并桡神经、正中神经损伤，肘关节处于屈肘100°、主动屈伸约20°，垂腕、垂指畸形、虎口挛缩，手指屈曲挛缩、僵硬，前臂桡背侧、屈侧麻木、感觉减退；4例一至两个针道有不同程度的渗出物，清创换药后治愈；1例创面出现小面积皮肤缺损，行游离植皮后愈合；其余病例创面均愈合良好，未出现医源性神经、血管损伤。提示外固定架联合负压封闭引流及背阔肌肌皮瓣移植是修复肱骨远端创伤性骨髓炎的有效手段。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

关键词: 植入物, 骨植入物, 骨髓炎, 肱骨远端, 外科皮瓣, 外固定架, 负压封闭引流, 疗效, Mayo肘关节评分, 国家自然科学基金

Abstract:

BACKGROUND: The treatment of osteomyelitis is a worldwide problem, how to improve the cures rate of osteomyelitis is a current research emphasis.
OBJECTIVE: To explore the effective treatment of traumatic osteomyelitis of the distal humerus by a combination therapy of external fixator, vacuum sealing drainage and pediculated latissimus dorsi myocutaneous flap transplantation.
METHODS: During May 2006 to September 2013, 36 patients with distal humeral traumatic osteomyelitis were enrolled in this study, and were treated with a combined treatment, including external fixator, vacuum sealing drainage and the pedicle latissimus dorsi myocutaneous flap. Mayo elbow scoring system was applied to evaluate elbow joint function preoperatively and postoperatively. We adopted follow-up with outpatient service, telephone tracked and family visited.
RESULTS AND CONCLUSION: All the involved 36 cases were followed up for 8 months to 6 years 8 months, average 4 years 3 months. The pedicle latissimus dorsi myocutaneous flaps were all survived, the biggest one was 40 cm × 13 cm and the least was 15 cm × 6 cm. 21 cases were treated using Orthofix external fixator, 11 cases with combined external fixator and 4 cases with Ilizarov circular external fixator. The fracture healing time was respectively 6-14 months, 10-16 months and 8-20 months. The average time of removing external fixator was 8 months. The postoperative elbow joint function was excellent in 3 cases, good in 19 cases, mild in 11 cases and poor in 3 cases. Among them, two cases recurred infection. At postoperative 3 months, 1 case appeared sinus again and was healed by debridement and iliac graft. One case with radial and median nerve injury had an elbow flexion of 100° and active extension active range of 20°, the wrist and fingers drop deformity was observed, fingers flexion contracted and stiffed, radial dorsal and flex sides of forearm were insensitive and subsided. Among the four cases, different degrees of tract exudation was visible in one or two pins, which cured after debridement and dressing. Small area skin defect in one case was healed after skin transplantation. Other cases were healed well, no iatrogenic nerve and vascular injury was observed. The combination therapy of external fixator, vacuum sealing drainage and pediculated latissimus dorsi myocutaneous flap transplantation is an effective treatment of traumatic osteomyelitis of the distal humerus.


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

Key words: osteomyelitis, external fixators, vacuum sealing drainage, surgical flap, follow-up

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