负压封闭引流联合开放性植骨术或骨搬移术治疗胫骨创伤性骨髓炎

Treatment of tibia traumatic osteomyelitis with vacuum sealing drainage combined with open bone graft or bone transportation

目的探讨负压封闭引流(VSD)联合开放性植骨术或骨搬移术治疗胫骨创伤性骨髓炎伴有皮肤软组织缺损的临床疗效。方法回顾性分析2012年1月至2013年6月24例胫骨创伤性骨髓炎患者的临床资料,其中男16例,女8例,年龄22~61岁,平均41.5岁。术前行创面细菌培养和药敏试验、X线及三维CT重建检查。清创后胫骨缺损长度为2~9 cm,平均(5.96±2.14)cm,创伤面积为3 cm×3 cm^9 cm×7 cm,平均(25.63±17.44)cm2。对5例骨缺损≤4 cm的患者进行清创、VSD、开放性植骨术,对19例骨缺损>4 cm的患者进行清创、VSD、骨搬移术。结果所有患者随访10~18个月,平均13.3个月。抗生素使用5~14 d,平均7.9 d,VSD治疗0~10次,平均2.9次。19例患者骨端自然愈合,愈合时间4~15个月,平均6.4个月,5例患者在骨搬移术后出现骨不连,经骨端嵌顿皮肤及软组织清理、骨髓腔打通、自体髂骨植骨及VSD后达到骨端愈合。2例患者治疗期间出现钉道感染,经抗生素治疗后感染控制,其余患者无感染复发。开放性植骨术或骨搬移术后1、2个月随访显示软组织缺损面积均较清创术后显著改善,差异有统计学意义(P<0.05);根据Paley骨折愈合评分标准优19例,良3例,中2例,差0例,总优良率为91.6%。结论 VSD联合开放性植骨术或骨搬移术是治疗胫骨创伤性骨髓炎伴有皮肤软组织缺损的有效方法。

Objective To discuss the efficacy of the treatment on tibia traumatic osteomyelitis with skin and soft tissue defect using vacuum sealing drainage(VSD)combined with open bone graft or bone transportation.Methods The clinical data of 24 patients of tibia traumatic osteomyelitis between January 2012 and June 2013 were retrospectively analyzed.There were 16 males and8 females,with the mean age of 41.5 years(range,22-66 years).Bacterial culture and drug sensitivity test,X ray examination and three-dimensional CT reconstruction were measured preoperatively.The length of tibia defect after debridement was 5.96±2.14 cm(range,2-9 cm),and the wound area was 25.63±17.44 cm2(range,3 cm×3 cm to 9 cm×7 cm).Five patients who had bone defect less than 4 cm were treated with debridement combined with open bone graft and VSD.Debridement combined with bone transportation and VSD were performed in the other 19 patients who had bone defect more than4 cm.Results All the patients were followed up for 10 to 18 months(mean,13.3 months).Antibiotic treatment was performed for 5 to 14 days(mean,7.9 days),and VSD was performed for 0to10times(mean,2.9times).Nineteen cases had bone healing within4to15 months(mean,6.4 months).The other 5 cases who had nonunion after bone transportation achieved bone healing after second operation,including debridement of the incarcerated soft tissue,marrow antrum perforation,autologous iliac bone graft and VSD.Two cases who had pin track infection were treated successfully with antibiotics.The area of soft tissue defects at post-operation 1 and 2 months was significantly better than that at pre-operation(P<0.05).According to the Paley fracture healing score standard,19 cases were excellent,3 cases were good,2 cases were average,the good rate was 91.6%.Conclusion VSD combined with open bone graft or bone transportation is an effective strategy for tibia traumatic osteomyelitis with soft tissue defect.