摘要
目的探讨膜诱导技术联合股前外侧穿支分叶嵌合组织瓣治疗内固定术后发生骨外露感染并伴有多发性腔隙性创面的可行性及疗效。方法2016年1月~2019年6月我院收治内固定术后发生骨外露感染的肢体多处腔隙性创面病人28例。保留原内固定钢板,采用载抗生素骨水泥占位骨缺损,股前外侧穿支分叶皮瓣修复皮肤缺损创面,嵌合肌瓣填塞骨外露腔隙。分叶皮瓣切取范围4 cm×6 cm~10 cm×16 cm,肌瓣切取范围3 cm×6 cm~6 cm×10 cm。供区直接闭合或植皮。在骨感染控制的情况下,术后12周取出骨水泥,利用自体髂骨制备成花生米大小的颗粒状充分植入诱导膜周围,如自体骨量不足,予以同种异体骨补充,修复骨缺损。结果术后28例皮瓣均顺利成活,22例一期骨感染得到治愈,二期行植骨后骨质临床愈合;6例一期感染未治愈,二期再行扩创、载抗生素骨水泥植入后感染治愈,再行植骨后骨质临床愈合。随访时间12~24个月,平均18个月。所有皮瓣颜色、质地良好,股四头肌肌力正常,膝关节活动无影响。结论膜诱导技术联合股前外侧穿支分叶嵌合组织瓣可同时解决骨感染以及伴有骨外露腔隙性创面。
Objective To investigate the feasibility and efficacy of the induced membrane technique combined with chimeric anterolateral thigh perforator leaf flap to cure limb exposed infection bone a nd multiple lacunar wounds.Methods From January 2016 to June 2019,28 patients with multiple lacunar wounds of limbs and bone exposure infection after internal fixation were treated in our hospital.The original internal fixation plate was retained,and the bone defect was occupied by antibiotic-loaded bone cement.The anterolateral femoral perforating branch lobular flap was used to repair the skin defect and wound,and the exposed bone space was filled with chimeric muscle flap.The wound area was from from 4 cm×6 cm to 8 cm×14 cm.Muscle flap resection range was about 3 cm×6 cm to 6 cm×10 cm.Direct closure of donor area or skin graft.Under the condition of bone infection control,bone cement was taken out 12 weeks after operation,and peanut sized granules were prepared by autologous iliac bone and fully implanted around the induction membrane.If the amount of autologous bone is insufficient,allogeneic bone should be added to repair the bone defect.Results All the 28 cases of flaps were survival well.And 22 cases of bone infection was cured at first intention,and the bone graft was clinical healed at second intention.6 cases of bone infection was cured after the second-stage expansion operation and antibiotic-containing bone cement implantation,then the bone graft was clinical healed.All patients were followed up for 12-24 months(mean 18 months).The color and texture of all flaps were good,the muscle strength of quadriceps femoris was normal,and the activity of knee joint was not affected.Conclusion Membrane induction technology combined with anterolateral femoral perforator and lobed chimeric tissue flap can simultaneously solve multiple wounds such as bone infection and bone exposed lacunar wounds.
作者
张广超
宋力
周树萍
胡智玉
宋德恩
杨涛
熊颖杰
陈佳
幸超峰
李士民
周明武
ZHANG Guangchao;SONG Li;ZHOU Shuping(Department of Trauma Orthopedics,988th Hospital of the Joint Logistics Support Force of PLA,Zhengzhou 450000,China)
出处
《临床外科杂志》
2022年第11期1078-1081,共4页
Journal of Clinical Surgery
基金
河南省医学科技攻关计划科研项目(LHGJ20190863)。
关键词
股前外侧穿支皮瓣
嵌合皮瓣
膜诱导技术
骨髓炎
anterolateral thigh perforator leaf flap
chimeric flap
induced membrane technique
osteomyelitis
