负压封闭引流结合开放植骨治疗慢性骨髓炎

Vacuum sealing drainage combined with open bone grafting for treatment of chronic osteomyelitis

目的探讨负压封闭引流（vacuum sealing drainage，VSD）技术结合开放植骨分步治疗慢性骨髓炎的临床疗效。方法选择2008年2月—2011年11月收治的15例慢性骨髓炎患者，采用多次清创和VSD治疗。判断创面是否有坏死组织及异常渗液，肉芽组织是否新鲜，确认在创面感染得到控制且有新鲜肉芽组织生长时，取自体髂骨开放植骨，换药至植骨表面肉芽生长，骨质外露消失后取薄皮片植皮消灭创面。结果所有患者均获随访14—58个月，平均22个月。治疗时间45—90d，平均60d。VSD引流21—59d，平均35d。感染控制、植骨消除骨死腔并且创面愈合14例，均未复发，1例感染未控制。结论VSD结合开放植骨分步治疗慢性骨髓炎，能有效控制感染、促进新鲜肉芽组织生长和骨愈合。

Objective To investigate the clinical effects of vacuum sealing drainage （VSD） combined with open bone grafting in treating chronic osteomyelitis. Methods The study enrolled 15 cases of chronic osteomyelitis treated by multiple debridement and VSD between February 2008 and No- vember 2011. Whether necrotic wounds and abnormal effusion existed were identified and whether granu- lation tissues were fresh were determined. Open grafting with autologous iliac was performed provided that the wound infection was controlled and fresh granulation tissues appeared. Dressing change continued un- til fresh granulation began to grow on the surface of bone grafts and thin grafts were used to cover the wound after bone exposure disappeared. Results Mean period of follow-up was 22 months （ range, 14- 58 months）. Mean duration of therapy was 60 days （range, 45-90 days）. Mean period of VSD was 35 days （range, 21-59 days）. Controlled infection, diminished dead cavity, and healed wounds were achieved in 14 cases without relapse, but infection remained uncontrolled in 1 case. Conclusion VSD combined with open bone grafting is an effective method to control infection and facilitate growth of fresh granulation tissues and healing.