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

doi:10.3969/j.issn.2095-4344.2014.48.016

Abstract

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

CLC Number:

R318

Shen Mei-hua, Aihemaitijiang•Yu-shu-fu, Ren Peng, Liu Ya-fei. Combination therapy of external fixator, vacuum sealing drainage and pediculated latissimus dorsi myocutaneous flap transplantation for distal humeral traumatic osteomyelitis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7797-7803.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入诊断为肱骨远端创伤性骨髓炎的患者36例，全部进入结果分析，无脱落。 2.2 随访结果本组36例全部获得随访，随访时间8个月至6年8个月，平均4年3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，骨折愈合时间为6-14个月；组合式外固定治疗11例，骨折愈合时间为10-16个月，Ilizarov环形外固定架治疗4例，骨折愈合时间为8-20个月。外固定架取出时间平均8个月。治疗后根据Mayo评分评估肘关节功能：优3例，良19例，中11例，差3例。 2.3 不良事件 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。 2.4 典型病例男性患者，33岁，维吾尔族。因创伤致左上肢疼痛、出血、活动受限2 d余于2013-03-10入院。入院查体：左上肢重度肿胀，左肱骨内侧可见约5 cm×6 cm皮肤软组织缺损，左肱骨后侧可见一约1 cm×2 cm创口，左肘关节畸形，活动受限，左肱骨外侧髁局部压痛，纵向扣击痛(+)，左前臂皮肤青紫，张力高，静脉回流障碍。左侧尺桡动脉搏动微弱，末梢血运欠佳。X射线示：左肱骨外髁及桡骨小头粉碎性骨折，左肘关节脱位。入院诊断：左前臂骨筋膜室综合征，左肱骨外髁及桡骨小头粉碎性骨折，左肘关节脱位，左肱骨皮肤、软组织撕脱伤，左肱三头肌挫裂伤。入院后急给予左肱骨及肘关节清创，骨折钛针内固定及负压封闭引流，见图1A。术后10 d，见肘关节局部有脓性渗出及坏死组织，再次行左肱骨及肘关节清创及负压封闭引流。二次清创后7 d第3次行左肘部清创，肱桡肌肌皮瓣转移，取皮植皮。术后因伤口感染，肱桡肌肌皮瓣坏死，见图1B。于2013-04-22行左肘关节骨髓炎病灶清除，组合式外固定架固定肘关节，背阔肌肌皮瓣修复，见图1C，D。术后3周，肌皮瓣存活，伤口愈合满意，见图1E。"

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