带蒂腓肠神经营养皮瓣联合诱导膜技术治疗跟骨骨髓炎的疗效分析

Therapeutic effect of pedicled sural neurotrophic flap combined with induction membrane technique for calcaneal osteomyelitis

目的探讨采用带蒂的腓肠神经营养皮瓣联合诱导膜技术治疗跟骨骨髓炎的临床疗效。方法回顾性分析自2014-01-2017-09诊治的10例跟骨骨髓炎患者的临床资料,均采用带蒂的腓肠神经营养皮瓣联合诱导膜技术治疗。术后评估皮瓣成活、创面和骨缺损的愈合、踝关节的功能恢复情况。结果所有患者获得随访,随访时间为平均19.5(9～36)个月。8例术后皮瓣成活良好,骨缺损区植骨后生长良好,无并发症的发生,2例腓肠神经营养皮瓣外缘出现坏死,跟骨外缘出现窦道和渗液,经清创和再次填充抗生素骨水泥后,并予VSD负压封闭引流术后,创面和骨髓炎区骨质愈合。末次随访时,本组一期骨与软组织愈合率为80%。依据美国足踝外科协会(AOFAS)踝-后足功能评分标准:优3例,良6例,中1例。结论采用带蒂的腓肠神经营养皮瓣联合诱导膜技术治疗跟骨骨髓炎术后皮瓣成活率高,感染控制和骨缺损修复良好,可以促进踝关节功能的早期恢复。

Objective To investigate the clinical efficacy of pedicled sural neurotrophic flap combined with induction membrane for calcaneal osteomyelitis. Methods The clinical data of 10 patients with calcaneal osteomyelitis treated from January 2014 to September 2017 were analyzed retrospectively. All of them were treated with pedicled sural neurotrophic flap combined with induction membrane technique. The survival of skin flap, the healing of wound and bone defect, and the functional recovery of ankle joint were evaluated after operation. Necrosis occurred on the outer edge of sural neurotrophic flap and sinus and exudation appeared on the outer edge of calcaneus in 2 cases. After debridement and refilling antibiotic bone cement and VSD negative pressure drainage, the wound and osteomyelitis area healed. Results All patients were followed up for an average of 19.5 (9-36) months. The flap survived well in 8 cases, and grew well after bone grafting in the bone defect area, and no complications occurred. At the last follow-up, the primary bone and soft tissue healing rate was 80%. According to (AOFAS) ankle-posterior foot function score, 3 cases were excellent, 6 cases were good and 1 case was fair. Conclusion Pedicled sural neurotrophic flap combined with induced membrane technique has high flap survival rate, good infection control and bone defect repair in the treatment of calcaneal osteomyelitis, which can promote the early recovery of ankle joint function.