股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎

Treatment of chronic osteomyelitis in the greater trochanter with pedicled muscle flap of the vastus lateralis muscle

目的报告股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎临床应用结果。方法自2008年1月至2015年1月,应用股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎6例(男5,女1)。患者年龄28~56岁(平均48岁)。粗隆部软组织缺损范围5 cm×2 cm^8 cm×4 cm。股外侧肌带蒂肌瓣转移至大粗隆部软组织缺损区,在肌瓣表面行一期中厚网状游离植皮,供区直接缝合。结果 1例肌瓣发生小片植皮坏死,经3周换药处理自然愈合。肌瓣全部成活。术后随访2.5~4.0年,平均3年,受区外形较好,慢性骨髓炎没有复发。髋关节功能用HSS评分标准评定其疗效,优5例,良1例。本组取得了较满意的临床效果。结论这种技术安全、可靠,很适用于治疗大粗隆部慢性骨髓炎。

Objective To report clinical application results of the treatment of chronic osteomyelitis in the greater trochan-ter with a pedicled muscle flap of the vastus lateralis muscle. Methods From Jan 2008 to Jan 2015, 6 patients （5 men, 1 women） with chronic osteomyelitis in the greater trochanter treated with a pedicled muscle flap of the vastus lateralis muscle. They ranged in age from 28 to 56 years （mean, 48 year）. Soft-tissue defect size in the greater trochanter were from 5 cm〉〈2 cm ？8 cm〉〈4 cm. The pedicled muscle flap of the vastus lateralis muscle was transposed to the greater tro-chanter area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. Results One patient developed small free skin graft necrosis, which spontaneous healed at 3 weeks after surgery. The muscle flaps had survived completely. Follow-up period ranged from 2.5-4.0 years （mean, 3 years） postoperatively. A good contour was confirmed at the recipient area. There was no recurrence of chronic osteomyelitis, the function of the hip joint were evaluated with HSS evaluation standards. Very good results were obtained in 5 cases, good results in 1 case. Satisfactory clinical results were obtained in tMs series. Conclusion This technique is safe, reliable, and particularly useful for the treatment of chronic osteomyelitis in the greater trochanter.