创伤性胫骨骨髓炎的治疗

Treatment of traumatic tibial osteomyelitis

目的：介绍创伤性胫骨骨髓炎的两种治疗方法,即改良腓肠肌内侧头肌皮瓣转移术和比目鱼肌肌瓣转移术。方法：自1989-2013年,共收治创伤性胫骨骨髓炎13例,开放性骨折所致4例,闭合性骨折开放手术所致9例,入院后均经换药,细菌培养加药敏试验,在病灶清除术的基础上,放置闭合性持续灌洗—引流管,用改良腓肠肌内侧头肌皮瓣或比目鱼肌肌瓣加植皮转移封闭创面。结果：12例获1次性治愈,1例术后感染未控制而转院,经1-3年随访,骨折愈合,骨髓炎无复发。治愈率95.3﹪。结论：改良腓肠肌内侧头肌皮瓣与比目鱼肌肌瓣加植皮转移术,操作简单,血运好,是治疗创伤性胫骨骨髓炎的首选方法。

Objective： To introduce two kinds of treatment methods of traumatic tibial osteomyelitis, namely modified medial gastrocnemius myocutaneous flap transfer operation and soleus muscle flap transfer operation. Methods： 13 cases with traumatic tibial osteomyelitis from 1989 to 2013 were treated including 4 cases caused by compound fracture and 9 cases caused by closed fracture operation. After admission, patients were treated by dressing, bacterial culture and drug sensitive test, based on debridement of the place, closed continuous irrigation - drainage tube, closed the wound with modified medial gastrocnemius myocutaneous flap or soleus muscle flap and skin grafting. Results：12 cases were cured, 1 cases had uncontrolled postoperative infection and transferred, after 1 to 3 years of follow-up, the fracture was cured with no recurrence of osteomyelitis. The curative rate was 95.3%. Conclusion： Modified medial gastrocnemius myocutaneous flap and the soleus muscle flap and skin grafting transfer operation is the preferred method for treatment of traumatic tibia with simple operation and good blood supply.