清创一期植骨及腓肠神经皮瓣治疗跟骨慢性骨髓炎伴软组织缺损

Efficacy of debridement and one-stage bone grafting combined with sural neurotropic skin flap transplantation on the treatment of chronic calcaneal osteomyelitis associated with soft tissue defect

目的探讨清创、一期植骨联合腓肠神经皮瓣移植治疗跟骨慢性骨髓炎伴软组织缺损的疗效。方法 2008年11月～2011年11月,对12例合并软组织缺损的跟骨慢性骨髓炎患者采用清创、一期植骨联合腓肠神经皮瓣移植修复创面,观察术后皮瓣成活、骨髓炎治愈及踝关节功能情况。结果术后随访9～24个月,平均17个月。9例皮瓣Ⅰ期愈合,3例窦道形成或边缘坏死经处理后愈合;随访期间无骨髓炎复发;根据美国足踝外科协会(AOFAS)踝后足功能评分术后(89.4±7.8)较术前(42.8±15.3)明显提高,差异有统计学意义(P<0.05)。结论跟骨慢性髓炎合并软组织缺损通过彻底清创、一期植骨及腓肠神皮瓣移植取得良好的效果,该方法具有疗效确切、疗程短、简单易行等特点。

Objective To investigate the efficacy of debridement and autogenous cancellous bone combined with sural neurotropic skin flap transplantation on the treatment of chronic calcaneal osteomyelitis complicated with soft tissue defect. Methods From November 2008 to November 2011, 12 patients of chronic calcaneal osteomyelitis with soft tissue defects were treated with debridement and autogenous cancellous bone combined with sural neurotropic skin flap transplantation in one-stage operation. And postoperative survival condition of flaps, recurrence of the osteomyelitis or not and the function of ankle were followed up. Results The patients were followed up for 9-24 months （an average of 17 months）, of which 9 cases were healed by first intension and 3 cases sinus formation or flap edge necrosis were second intension following corresponding treatment. During follow-up periods, no patients with osteomyelitis recurrenced. According to the AOFAS scores of ankle-foot function, the excellent, good and fair were in 9, 2 and 1 case respectively. Conclusion Chronic calcaneal osteomyelitis associated with soft tissue defect can achieve good outcome through debridement and autogenous cancellous bone combined with sural neurotropie skin flap transplantation and this method has the advantage such as obvious curative effect, short therapeutic course and simple procedures.