CAJ | 학술논문

目的分析胫骨平台骨折钢板固定术后伤口感染的原因,探讨总结应用小腿近侧蒂肌皮瓣治疗方法的疗效.方法 2005年1月至2009年5月,经治胫骨平台骨折钢板内固定术后并发伤口感染不愈、软组织缺损、钢板外露、创伤性骨髓炎52例.彻底扩创、清理死骨、对髓腔开放者清理髓腔,并取不同层次炎性肉芽组织送实验室细菌学及药敏测试,对钢板固定失效者更换外固定架.创腔内放置载万古霉素或妥布霉素硫酸钙人工骨,骨缺损较大者,取自体髂骨混合植骨,选取小腿近侧蒂皮瓣填充覆盖修复创面.放置引流,抗生素静脉注射3至4周,定期拍摄X线片直至骨折愈合.结果 52例组织缺损均得到满意修复.随访时间最长5年,最短1年,骨折愈合最快4个月,最长1年.2例术后分别于第3、4个月骨髓炎复发再次手术治愈.3例术后6个月骨折不愈再次手术植骨后4～6个月愈合.结论胫骨平台骨折钢板内固定术后并发伤口感染不愈软组织缺损、创伤性骨髓炎的治疗需要综合措施,应用小腿近侧蒂相应肌皮瓣填充创腔、覆盖闭合修复缺损创面、改善局部血供、促进骨折愈合是取得治疗成功不可或缺的方法之一.
목적 분석경골평태골절강판고정술후상구감염적원인,탐토총결응용소퇴근측체기피판치료방법적료효.방법 2005년1월지2009년5월,경치경골평태골절강판내고정술후병발상구감염불유、연조직결손、강판외로、창상성골수염52례.철저확창、청리사골、대수강개방자청리수강,병취불동층차염성육아조직송실험실세균학급약민측시,대강판고정실효자경환외고정가.창강내방치재만고매소혹타포매소류산개인공골,골결손교대자,취자체가골혼합식골,선취소퇴근측체피판전충복개수복창면.방치인류,항생소정맥주사3지4주,정기박섭X선편직지골절유합.결과 52례조직결손균득도만의수복.수방시간최장5년,최단1년,골절유합최쾌4개월,최장1년.2례술후분별우제3、4개월골수염복발재차수술치유.3례술후6개월골절불유재차수술식골후4～6개월유합.결론 경골평태골절강판내고정술후병발상구감염불유연조직결손、창상성골수염적치료수요종합조시,응용소퇴근측체상응기피판전충창강、복개폐합수복결손창면、개선국부혈공、촉진골절유합시취득치료성공불가혹결적방법지일.
Objective To analyze the reason of post-operative infection of tibial plateau fracture, the therapeutic effect of using pedicle musculocutaneous flaps of proximal leg was researched and summarized. Methods There were 52 patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis from January 2005 to May 2009. After pre-operative physical examination, laboratory examination, X-ray, CT scan and bacterial culture of the secretion,the operation, such as debridement, dead bone moving, medullary cavity cleaning, transferring to the external fixation when the internal fixation lost efficacy and bacterial culture of granulation tissue of different levels. The cavity was filled with RBK combined with vancomycin or tobramycin. If the cavity was rather large, autografts from the iliac bone were combined. The tissue defects were covered with pedicle musculocutaneous flaps of proximal leg, and the wound had effective drainage. The antibiotic was used for 3-4 weeks, and the X-rays were given at fixed period until the fracture was cured. Results The soft tissue defects of all 52 patients were repaired well. They were followed from 1 year to 5 years, and the time of bone union ranged from 4 months to 1 year. Two patients of osteomyelitis had a relapse after 3,4 months, then they were cured by the second operation. Three patients had unhealed fracture after 6 months, then they were cured by bone grafting again after 4-6 months. Conclusion Patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis should be cured by comprehensive treatments, one of the crucial treatment for success is using pedicle musculocutaneous flaps of proximal leg to fill in lacuna, close wound, improve the local blood supply and promote bone union.