腓肠肌肌皮瓣治疗胫骨创伤性慢性骨髓炎伴骨与软组织缺损

Reconstuction of traumatic tibia chronic osteomyelitis combined with bone and soft tissue defect with gastrocnemius musculocutaneous flap

目的探讨应用多种腓肠肌肌皮瓣转移治疗胫骨创伤性慢性骨髓炎伴骨与软组织缺损的临床选择及效果。方法 2005年6月—2008年6月,对16例胫骨慢性创伤性骨髓炎合并骨缺损骨外露的患者,采用病灶清除,骨质缺损较多行Ⅰ期或Ⅱ期植骨,外固定支架固定,分别应用腓肠肌内侧头肌皮瓣、腓肠肌外侧头肌皮瓣、腓肠肌内外侧头联合肌皮瓣、腓肠肌内或外侧头肌瓣加植皮,术后常规滴注引流进行治疗。男14例,女2例,年龄17～59岁。皮瓣面积6 cm×4 cm～18 cm×9 cm。结果随访6～24月,全部转移皮瓣一期存活。Ⅰ期植骨2例,Ⅱ期植骨4例1,例慢性骨髓炎复发,植骨失败,经3次清创后感染治愈;其余病例感染均未复发,植骨愈合好,植骨愈合时间3.4～6.7月,平均4.6个月。结论腓肠肌肌皮瓣具有血供丰富、操作简单、成活率高以及不牺牲重要血管等特点。治疗胫骨创伤性慢性骨髓炎并骨与软组织缺损,既可以改善病灶局部血液循环、又可以进行创面覆盖,同时还可以进行滴注引流,提高疗效,缩短病程,减少费用,是一种切实可行的有效方法。

Objective To explore the therapeutic effects of various gastrocnemius musculocutaneous flaps for the reconstruction of traumatic tibia chronic osteomyelitis combined with bone and soft tissue defect.Methods From June 2005 to June 2008,16 cases of traumatic tibia chronic osteomyelitis combined with bone and soft tissue defect were treated with debridement,one-stage or two-stage bone grafting（for severe bone defect）,external fixation,and transferring of medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap,medial head combined with lateral head of gastrocnemius muscle flap,skin graft with medial head or lateral head of gastrocnemius muscle flap.There were 14 males and 2 females of all the cases,and their ages ranged from 17 to 59.The area of the flaps ranged from 6cm×4cm to 18cm×9cm.Results All cases were followed up for 6 to 24 months.All flaps survived after operation.Two cases had one-stage bone graft while four cases had two-stage bone graft.One patient had osteomyelitis recurrences and osseous nonunion and the infection was cured after three debridements.No recurrence of osteomyelitis was observed in the other 15 patients and satisfactory healing of the grafted bone was observed within 3.4 to 6.7 months（average 4.6 months）.Conclusion Gastrocnemius musculocutaneous flap is characterized by reliable blood supply,easy and fast elevation and high survival rate.It represents an ideal choice for the reconstruction of traumatic tibia chronic osteomyelitis combined with bone and soft tissue defect because it can not improve local blood circulation of the lesion area and cover the defect.The results can be further improved if drip drainage is performed simultaneously.In conclusion,gastrocnemius musculocutaneous flaps are effective and reliable solutions for the reconstruction of traumatic tibia chronic osteomyelitis combined with bone and soft tissue defect.