组织瓣移植修复治疗胸骨骨髓炎

Tissue flap transplantation in the treatment of sternal ostemyelitis

目的:归纳总结组织瓣移植修复胸骨骨髓炎的方法,并对其有效性、安全性及优缺点作出比较。资料来源:共收集中英文两种文献资料。中文检索资料来源于中国医院知识仓库,检索词为“胸骨,骨髓炎”,选择摘要为检索项,检索时间为1994～2004年。同时应用Pubmed检索外文文献,检索时限为最近10年,检索词为“sternal osteomyelitis flap surgery”,并限定文章语言种类为English。资料选择:对检索到的所有文献进行整理,挑选治疗手段为各种组织瓣移植方法的信息。选取针对性强的文章,对不同类别的组织瓣移植方法予以归类、总结、精炼。资料提炼:共检索到中文文献14篇,其中9篇符合要求,排除5篇,英文相关文献检索到24篇,其中13篇符合要求,排除11篇。此外,根据各文献所列参考文献中再次收集选取针对性强的文章,最后选定32篇。资料综合:胸骨骨髓炎一直是临床面临的难题之一,其治疗包括保守治疗和积极的手术治疗。其中,保守治疗费时费力,且通常不能奏效。组织瓣移植已是目前胸骨骨髓炎的主要手术治疗手段,根据各种组织瓣的不同,可分为腹直肌肌皮瓣、背阔肌肌皮瓣、胸大肌肌皮瓣、大网膜移植等。各种方法均有其治疗特点,针对合适的病患,都能取得满意的治疗效果。结论:组织瓣移植是治疗胸骨骨髓炎的一种可靠方法,但清创的作用也不容低估。由于各种组织瓣各具优缺点,因此,具体手术方案的选择应当根据患者的具体条件来确定。只有充分考虑到病变的特点、受区、供区的状况,选择相应的组织瓣,手术才能获得成功。

OBJECTIVE： To summarize the methods of handling sternal ostemyelitis after tissue flap transplantation and make a comparison at its validity, safety, merit and defect. DATA SOURCES： We collected literatures in both Chinese and English. The Chinese literature rooted from China Hospital Knowledge Database between 1994 and 2094, the search words wore ＂sternal, ostemyelitis＂ in summary item. Pubmed was used to search English literature, the search time was limited to recant 10 years, the search words were ＂sternal osteomyelitis, flap surgery.＂ STUDY SELECTION： We sorted all the literatures that had been searched and chose the treatment as the information of all kinds of tissue flap transplantation. Then the articles with strong pertinence were selected to categorize, summarize and refine all kinds of tissue flap transplantation. DATA EXTRACTION： Totally 14 Chinese articles were searched, including 9 met the requests and 5 were expelled. And 24 English related articles were searched, 13 of them met the requests, expelling 11. In addition, the articles with strong pertinence were recollected in the references of these articles. DATA SYNTHESIS： The sternal ostemyelitis has been one of the difficult problems to the clinical doctors. Its treatment includes conservative treatment and active surgical operation. Among them, the conservative treatment takes time and energy, and usually can＇t work out. Tissue flap transplantation has already been the main surgical treatment of the sternal ostemyelitis currently. According to the difference of tissue flap, it is divided into rectus abdominis musculo cutaneous flap, latissimus dorsi musculo cutaneous flap, pectoralis major musculo cutaneous flap and greater omentum transplantation etc. All the treatments have its characteristics and can obtain satisfied curative effect aiming at proper patients. CONCLUSION： Tissue flap transplantation is a credible method for the treatment of stemal ostemyelitis. But effect of the debridement should not be underestimated. As each tissue flap has its own merit and defect, the selection of the surgical project should be based on patient＇s concrete condition. Only with the total consideration of the characteristics of disease, the condition of the receive area and supply area, the corresponding choice of relevant tissue flap, can the surgical operation succeed.