CAJ | 학술논문

目的报道逆行腓肠神经营养血管肌皮瓣加置管抗生素溶液冲洗在慢性外踝骨髓炎中的应用.方法从2000年3月至2008年3月,共收治外踝慢性骨髓炎17例,为外伤致外踝部开放性骨折治疗不当发展为外踝骨髓炎,将外踝部肉芽创面清理,外踝开窗反复刮除后,采用逆行腓肠神经营养血管肌皮瓣修复创面.皮瓣切取面积最大7 cm×11 cm,最小5 cm×6 cm.皮瓣均带有厚约1 cm腓肠肌外侧头肌.在复合皮瓣缝合于创面之前,通过正常组织穿刺,放置一无菌硬膜外麻醉管至外踝髓腔内,以便于术后根据细菌培养结果通过该管向骨髓腔内注射细菌敏感抗生素.结果术后皮瓣均成活.通过硬膜外麻醉管注射抗生素1个月后,15例外踝未见红肿、无异常分泌物及温度升高,C反应蛋白检测值降至正常范围,遂拔出硬膜外管.2例皮瓣远端有一约1 cm伤口未愈,伤口内有脓性分泌物.再次细菌培养加药敏检测后,调整经管注射药物及加强换药后约1.5个月,伤口闭合,未见再有异常分泌物,C反应蛋白降至正常后,拔除硬膜外管.皮瓣外形满意,功能良好.随访1～8年,未见骨髓炎复发.结论腓肠神经营养血管肌皮瓣加置管冲洗是治疗外踝骨髓炎伴局部软组织缺损的一种简单有效方法.
목적 보도역행비장신경영양혈관기피판가치관항생소용액충세재만성외과골수염중적응용.방법 종2000년3월지2008년3월,공수치외과만성골수염17례,위외상치외과부개방성골절치료불당발전위외과골수염,장외과부육아창면청리,외과개창반복괄제후,채용역행비장신경영양혈관기피판수복창면.피판절취면적최대7 cm×11 cm,최소5 cm×6 cm.피판균대유후약1 cm비장기외측두기.재복합피판봉합우창면지전,통과정상조직천자,방치일무균경막외마취관지외과수강내,이편우술후근거세균배양결과통과해관향골수강내주사세균민감항생소.결과 술후피판균성활.통과경막외마취관주사항생소1개월후,15예외과미견홍종、무이상분비물급온도승고,C반응단백검측치강지정상범위,수발출경막외관.2례피판원단유일약1 cm상구미유,상구내유농성분비물.재차세균배양가약민검측후,조정경관주사약물급가강환약후약1.5개월,상구폐합,미견재유이상분비물,C반응단백강지정상후,발제경막외관.피판외형만의,공능량호.수방1～8년,미견골수염복발.결론 비장신경영양혈관기피판가치관충세시치료외과골수염반국부연조직결손적일충간단유효방법.
Objective To describe the method and clinical result of super sural neuromusculocutaneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male 14, femal 3, 21 to 75 years old (average 43-year-old),were underwent reversed saphenous musculocutaneous island flap after wide excision of lateralmalleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm× 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation, the wounds were irrigated with sensitive antibiotics 1 to 2.5 months(average 49 days), and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month.The 2 cases were not healed at first stage. According to the lab result,we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.