腓肠神经营养血管远端蒂皮瓣结合抗生素硫酸钙治疗跟骨慢性骨髓炎

Treatment of chronic osteomyelitis of calcaneus with distally based sural neurovascular flap and antibiotic calcium sulfate

背景:跟骨慢性骨髓炎是跟骨骨折术后发生的较为严重的并发症之一,其发生率日益增加,且处理较为棘手。目的:探讨应用腓肠神经营养血管远端蒂皮瓣及抗生素硫酸钙治疗跟骨慢性骨髓炎的方法和疗效。方法:回顾性研究2016年1月至2019年10月治疗的19例跟骨骨折所致跟骨慢性骨髓炎患者,男11例,女8例;年龄35~65岁,平均(45.0±6.4)岁。病程2~15个月,平均(6.5±2.3)个月。彻底清创后采用腓肠神经营养血管远端蒂皮瓣移位结合抗生素硫酸钙治疗,皮瓣范围为4 cm×5 cm至6 cm×10 cm。根据美国足踝外科协会(AOFAS)后足功能评分对治疗前后的足踝功能进行评价。结果:所有患者术后均获随访,随访时间8~36个月,平均(12.5±5.6)个月,可正常穿鞋行走,局部皮肤完整,无红肿热痛及窦道流脓情况。AOFAS的踝、后足评分:治疗前为(53.4±2.3)分,治疗后8个月改善至(76.6±3.4)分,差异有统计学意义(P<0.05);其中优7例,良10例,可2例。1例患者术后1个月复发,二次病灶清除,药敏试验示真菌感染,置管冲洗引流3周后感染控制;所有患者未行二期植骨,2例负重后跟骨后关节面发生塌陷,但无明显临床症状。所有患者均恢复正常的日常生活及重返工作。结论:腓肠神经营养血管远端蒂皮瓣结合抗生素硫酸钙治疗跟骨慢性骨髓炎是完全可行的。

Background:Chronic osteomyelitis of the calcaneus is one of the severe complications after surgery for calcaneal fracture.Its incidence is increasing day by day,and it is very troublesome to deal with.Objective:To investigate treatment method and clinical outcome of chronic calcaneus osteomyelitis with the sural neurovascular flap and antibiotic calcium sulfate.Methods:Nineteen patients with chronic calcaneal osteomyelitis caused by calcaneal fracture treated from January 2016 to October 2019 were retrospectively analyzed.There were 11 males and 8 females with an average age of(45.0±6.4)years old(range,35-65 years).The mean course of disease was(6.5±2.3)months(range,2-15 months).After complete debridement,the distal sural neurovascular pedicle myocutaneous flap was transferred and antibiotic calcium sulfate was applied.The flap range was 4 cm×5 cm to 6 cm×10 cm.The AOFAS ankle and hind foot score was used to evaluate ankle function.Results:All patients were followed up for 8-36 months(average[12.5±5.6]months).They could walk with shoes on,local skin was intact,and there was no redness,swelling,hot pain or sinus pus.The AOFAS score at 8 months after of treatment was significantly higher than that before treatment(76.6±3.4 vs 53.4±2.3,P<0.05).The clinical result was excellent in 7 cases,good in 10 and fair in 2.One patient recurred one month after operation,the debridement was used again.The drug sensitivity test showed fungal infection which was controlled 3 weeks after washing and drainage.No patient had secondary bone grafting.The posterior articular surface of calcaneus collapsed in 2 cases,but there were no obvious clinical symptoms.All patients returned to normal daily life and work.Conclusions:It is feasible to treat chronic calcaneus osteomyelitis with sural neurovascular pedicle flap combined with antibiotic calcium sulfate,which brings a new method to treat calcaneus osteomyelitis.