Fan Jinzhu, Cong Fei, Ren Xiaoyu, Zhang Ke, Song Tao
Department of Bone Microsurgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 May 15;36(5):614-618. doi: 10.7507/1002-1892.202201031.
To investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect.
A clinical data of 33 patients with post-traumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018 was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of 39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲ and 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years (median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm (mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation.
The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months (mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months (mean, 5 months). The clinical healing time was 4-14 months (mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%.
For the post-traumatic tibial osteomyelitis with soft tissue defect, the flap combined with induced membrane technique is a reliable and effective method and can effectively restore the function of lower limbs with satisfactory effectiveness.
探讨皮瓣联合诱导膜技术治疗创伤后胫骨骨髓炎合并软组织缺损的疗效。
回顾性分析2015年8月至2018年10月间33例符合入选标准的创伤后胫骨骨髓炎合并软组织缺损患者的临床资料。其中男性21例，女性12例。年龄19～70岁，平均39岁。骨髓炎位于胫骨上段1/3者8例，中段1/3者14例，下段1/3者11例。根据Cierny-Mader分类标准，Ⅲ型骨髓炎19例，Ⅳ型骨髓炎14例。骨髓炎病程2个月至20年（中位病程3个月）。一期手术彻底清创后，骨缺损长度为1.5～12.5 cm（平均5.0 cm），软组织缺损面积为5 cm×4 cm至15 cm×12 cm。将含抗生素的骨水泥植入骨缺损处，并采用个体化皮瓣修复创面。6～8周伤口愈合、感染得到控制后，二期手术行植骨修复骨缺损。
一期手术后皮瓣完全存活29例，4例皮瓣部分坏死，经换药后愈合。二期手术后所有切口均Ⅰ期愈合。所有患者均获随访，随访时间24～32个月（平均28个月）。所有植骨术后均愈合，影像学愈合时间为3～9个月（平均5个月），临床愈合时间为4～14个月（平均8个月）。随访期间无骨髓炎复发。末次随访时，根据Johner-Wruhs评价标准，肢体功能优27例，良4例，可2例，优良率为93.9%。
对于创伤后胫骨骨髓炎合并软组织缺损，皮瓣联合诱导膜技术是一种可靠有效的方法，能有效恢复下肢功能，疗效满意。
