负压辅助愈合治疗系统对儿童骨髓炎的治疗体会及文献复习

Vacuum-assisted closure healing therapy system for osteomyelitis in children treatment experience and review of literature

目的探讨负压辅助愈合治疗系统(VAC)对儿童骨髓炎治疗的临床价值。方法搜集2017年7月至2019年4月于我院经影像检查及病理确诊的65例骨髓炎患儿(其中急性59例,慢性6例)的病历资料进行回顾性分析。所有患儿均接受VAC治疗,记录患儿手术次数、住院天数、术后体温恢复正常天数、创面愈合及预后随访情况,与相关文献报道比较,分析VAC治疗儿童骨髓炎的疗效。结果 65例骨髓炎患儿手术次数1.0-8.0次,平均(2.7±1.1)次;随访时间6.0-18.0个月,平均8.3个月;62例预后良好,2例发生肢体畸形,1例复发再次手术。59例急性骨髓炎中,其中1例症状不典型,术前行穿刺活检病理确诊;58例急性骨髓炎住院18.0-84.0 d,平均(29.4±12.8)d;其中23例患儿入院时伴有发热,VAC治疗后,术后体温恢复至正常天数1.0-10.0 d,平均(4.8±2.2)d。59例急性骨髓炎患儿中,3例发生漏气,2例发生管道堵塞。本研究结果与传统的负压封闭引流技术(VSD)相比,效果显著。结论采用VAC技术治疗儿童骨髓炎效果良好,患儿痛苦小,护理方便。

Objective To investigate the clinical value of vacuum-assisted closure(VAC) in the treatment of osteomyelitis in children. Methods The medical records of 65 cases were collected for retrospective analysis. These cases were of 65 children with osteomyelitis and among them, 59 were acute and 6 were chronic. They were diagnosed at our hospital from July 2017 to April 2019 by imaging and pathological confirmation. All children were treated with VAC. The number of operations, days in the hospital, days to normal temperature, wound healing, and prognostic follow-up of the children were recorded. These were compared with relevant literature reports to analyze the efficacy of VAC in the treatment of osteomyelitis in children. Results Number of operations in 65 children with osteomyelitis 1.0 to 8.0, mean(2.7±1.1). Follow-up time was from 6.0 to 18.0 months, with a mean of 8.3 months. The prognosis was good in 62 cases, with 2 cases of limb deformity and 1 case had recurrence and reoperation.Among the 59 cases of acute osteomyelitis, 1 case had atypical symptoms, and the diagnosis was confirmed by preoperative puncture biopsy pathology. Fifty-eight cases of acute osteomyelitis were hospitalized for 18.0 to 84.0 days, with a mean of(29.4±12.8) days. Twenty-three children were admitted with fever. After VAC treatment, the number of days after surgery to normal temperature ranged from 1.0 to 10.0 days, with a mean of(4.8±2.2) days. Of the 59 patients with acute osteomyelitis, 3 had air leakage, and 2 had a blockage.Compared with the traditional VSD in the treatment of acute osteomyelitis, the result of this study has an obvious effect. Conclusions The VAC technique is highly effective in treating osteomyelitis in children,with minimal pain and easy care.