CAJ | 학술논문

目的探讨吻合血管的骨瓣移植治疗Cierny-MaderⅢ、Ⅳ型胫骨骨髓炎的疗效. 方法对2010年5月至2014年6月收治的28例胫骨骨髓炎患者资料进行回顾性分析,男21例,女7例;年龄16～61岁,平均42.1岁;均为创伤后所致骨感染,治疗周期18个月至12年;Cierny-Mader分型:ⅢA9例、ⅢB型6例,ⅣA型10例,ⅣB型3例.行病灶扩大切除后分别切取带血管腓骨移植7例,带血管腓骨骨皮瓣10例,带血管髂骨瓣移植11例修复胫骨骨缺损.结果所有患者术后获12个月至4年(平均32.3个月)随访,骨皮瓣全部存活.3例患者窦道延迟愈合,1例再次窦道形成.根据Paley治疗感染性胫骨骨不连优良评分标准,骨性结果功能均为优良.根据Johner-Wruhs胫骨干骨折评价标准:优21例,良7例.结论 Cierny-MaderⅢ、Ⅳ型胫骨骨髓炎行病灶彻底清创后,应用吻合血管的骨瓣移植修复胫骨缺损可取得较好的临床疗效.
목적 탐토문합혈관적골판이식치료Cierny-MaderⅢ、Ⅳ형경골골수염적료효. 방법 대2010년5월지2014년6월수치적28례경골골수염환자자료진행회고성분석,남21례,녀7례;년령16～61세,평균42.1세;균위창상후소치골감염,치료주기18개월지12년;Cierny-Mader분형:ⅢA9례、ⅢB형6례,ⅣA형10례,ⅣB형3례.행병조확대절제후분별절취대혈관비골이식7례,대혈관비골골피판10례,대혈관가골판이식11례수복경골골결손.결과 소유환자술후획12개월지4년(평균32.3개월)수방,골피판전부존활.3례환자두도연지유합,1례재차두도형성.근거Paley치료감염성경골골불련우량평분표준,골성결과공능균위우량.근거Johner-Wruhs경골간골절평개표준:우21례,량7례.결론 Cierny-MaderⅢ、Ⅳ형경골골수염행병조철저청창후,응용문합혈관적골판이식수복경골결손가취득교호적림상료효.
Objective To report our experience of treating tibial osteomyelitis of Cierny-Mader type Ⅲ or Ⅳ using vascularized bone graft.Methods From May 2010 to June 2014,we treated 28 patients with tibial osteomyelitis which was caused by post-traumatic bone infection.They were 21 men and 7 women,aged from 16 to 61 years (average,42.1 years).Their entire treatment lasted from 18 months to 12 years.According to Cierny-Mader classification,9 cases were type ⅢA,6 cases type ⅢB,10 cases type ⅣA,and 3 cases type Ⅳ B.After lesions were resected extensively,vascularized free fibula transplantation was performed in 7 cases,vascularized free fibula transplantation plus skin flap in 10 cases and vascularized free iliac bone transplantation in 11 cases to manage tibial bone defects.Results Their follow-up periods ranged from 12 to 48 months (mean,32.3 months).All the osteocutaneous flaps survived.Delayed healing of sinus tract occurred in 3 patients and formation of sinus tract recurred in one.According to Paley criteria for management of infectious tibial nonunion,all cases achieved an excellent or good outcome in both bony and functional aspects.According to Johner-Wruhs criteria for tibial diaphyseal fracture,21 cases were rated as excellent and 7 as good.Conclusion For treatment of tibial osteomyelitis of Cierny-Mader type Ⅲ or Ⅳ,application of vascularized bone graft after extensive resection of the lesion can be effective.