大腿剔骨皮瓣修复脊髓损伤患者髋关节周围难治性压疮

Total thigh musculocutaneous flap in reconstruction of refractory pressure ulcers around hips in patients with spinal cord injury

目的:探讨修复脊髓损伤患者髋关节周围危及生命难治性压疮的方法和疗效。方法:2012年3月至2015年6月,采用高位股骨截骨或髋离断形成血供丰富的大腿剔骨肌皮瓣修复8例脊髓损伤患者髋关节周围危及生命的难治性压疮。其中男7例,女1例;年龄35~68岁,平均(52.0±2.6)岁。病程10个月~7年,平均(2.9±0.2)年。所有患者为包括2个部位以上的复杂压疮,除1例未引起髋关节感染外,其余7例压疮均合并同侧髋关节内感染。单个压疮表面面积最小3 cm×3 cm,最大12 cm×15 cm。术后观察感染控制,创面愈合,营养状况改善和生活质量提高情况。结果:8例患者均获得随访,随访时间3个月~2年,平均1.3年。所有患者皮瓣成活,其中5例创面Ⅰ期愈合,2例皮瓣愈合不良,经扩创缝合后Ⅱ期愈合。1例远段小块皮瓣坏死,经换药愈合。术中尿道损伤1例,经尿道修补痊愈。所有创面得到有效覆盖,局部感染控制,营养情况及生活质量较术前明显改善,随访期间,无创面感染及皮瓣覆盖部位压疮复发病例。结论:大腿剔骨肌皮瓣能有效修复脊髓损伤患者髋关节周围危及生命的难治性压疮创面。虽以失去整个下肢为代价,但在没有其他更好的办法时,它仍然是一种挽救生命的好方法。

Objective：To discuss the treatment of life threatening refractory pressure ulcers around hips in patients with spinal cord injuries（SCI）and evaluate its clinical outcomes. Methods：From March 2012 to June 2015,eight paraplegic patients with life threatening refractory pressure ulcers around hips were treated with total thigh musculocutaneous flaps following amputation of proximal femurs or hips,including 7 males and 1 female with an average age of（52.0±2.6） years old ranging from 35 to 68. The coures of disease was from 10 months to 7 years with a mean of（2.9±0.2） years. All the 8 patients had compound ulcers of more than two parts,7 cases had hip infection on the same side. The area of superficial wounds ranged from3.0 cm×3.0 cm to 12.0 cm×15.0 cm. The clinical effects were evaluated according to infection controlling,wound healing,improving of nutrition and life quality of patients. Results：All patient were followed up for 3 months to 2 years with an average of1.3 years. All flaps survived,5 cases obtained wound healing at one stage,2 cases had wound dehiscence and the wounds were closed after a second operation,1 case had partial flap necrosis which was healed by dressing change,1 case had urethral injury that was repaired in operation. All wounds were cured successfully without infection and ulcer recurrence during the follow up period. The nutrition and quality of life of all cases improved observably after operation. Conclusion：The total thigh musculocutaneous flap is effective to reconstruct the refractory pressure ulcers around hip of patient with SCI. It can rescue life at the cost of losing one lower limb. It is an operation of last resort for the patients.