Iwakiri Kentaro, Miyauchi Akira, Okuda Shinya, Matsuda Ken, Yamamoto Tomio, Iwasaki Motoki
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Neurosurg Spine. 2008 May;8(5):468-72. doi: 10.3171/SPI/2008/8/5/468.
This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a 1-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric O(2) treatment, subsided and stabilized within 1 year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers.
本报告描述了一种有效的技术，即使用全腿皮瓣治疗一名57岁的男性截瘫患者，该患者患有由耐甲氧西林金黄色葡萄球菌引起的难治性骶部化脓性脊柱炎。脊柱炎伴有腰骶部严重不稳定、巨大的腰骶部溃疡以及大面积的骨与肌肉缺损，这使得患者难以维持坐姿。全腿皮瓣手术是对全大腿皮瓣手术的一种改良，作为一期挽救手术进行。将带血管的胫骨和腓骨移植于腰椎和骶椎之间，并使用肌皮瓣覆盖腰骶部皮肤缺损处的广泛溃疡。尽管反复进行清创、静脉注射抗生素、糖治疗、派罗宁治疗和高压氧治疗，但该难治性腰骶部脊柱病变超过2年未愈，而在手术1年内病情消退并稳定。患者使用轮椅恢复了日常生活活动，对结果非常满意。使用带血管胫骨移植的全腿皮瓣是治疗伴有大面积骨缺损和巨大腰骶部溃疡的难治性化脓性脊柱炎的有效方法。
