慢性骨髓炎的手术治疗

Chronic osteomyelitis treated by operation

目的 观察不同手术方法对慢性骨髓炎的治疗效果,方法 31例32骨慢性骨髓炎中,胫骨20,股骨5,跟骨3,跗骨2,趾骨1,骼骨1。血源性5,开放骨折感染25,枪伤1。血源性病期:平均10年,外伤感染4个月～4年,枪伤30年。彻底病灶清除残留骨腔大者,以肌瓣或肌皮瓣填塞14骨,无大骨腔者闭合伤口抗菌素灌洗5骨,Orr's疗法12骨,病骨切除1。结果 随诊3个月～5年,14骨肌瓣填塞均一期愈合,其中2例骨缺损行植骨又愈合良好;灌洗5例,4例愈合,1例髂骨愈合3个月后复发,病骨切除1期愈合Orr's疗法在4～6个月愈合11骨,1跟骨术后8个月尚有分泌物。结论 彻底清除炎性病灶是治愈慢性骨髓炎的关键措施,髂骨、跟骨病灶较难彻底清除,是未愈的主要原因。有骨胜者肌瓣填塞,无骨腔者灌洗治疗可一次愈合。Orr's疗法,可在6个月内愈合,适于无肌瓣填塞的部位。

Objective To observe the results of chronic osteomyelitis treated by various operation. Materials There were 32 bone lesions in 31 cases in which 20 in tibiae, 5 in femora, 3 in calcanea, 2 in tarsi; 1 in phalanx and I in ilium. The causes of chronic osteomyelitis were haematogenous in 5 cases, infected open fracture in 25 and gunshot in 1. The duration of osteomyelitis varied from 4 months to 4 years in open fracture, average 10 years in haematogenous osteomyelitis and 30 years in gunshot. Methods The lesion were thoroughly excised and filled by muscular flap or mus- culocutaneous in large bony cavity in 14 cases, irrigation with antibiotics in small bony cavity in 5 cases, Orr's operation in 12 cases and excision of phalanx in 1 case. Results All cases had been followed - up from 3 months to 5 years. All of 14 cases that filled by muscular flap were all healed in primary stage. 4 cases of irrigation method healed and 1 case of ilium osteomyelitis recurred 3 months later. There were 11 cases of Orr' s method healed in 4 - 6 months ami one case of calcaneus did not heal until 8 months. The case of phalanx excision was healed. Conclusions ①Thoroughly excision of osteomyelitis is a key step in the treatment of chronic osteomyelitis, As for ilium or calcaneus, it was difficult to clean away thoroughly , thus this was the reason of recurrence. ②Muscular flap filling was the choice of treatment for large bony cavity and irrigation for small bony cavity.③Orr's treatment may be used at the site where muscular flap was not available and bone healing occurred within 4 - 6 months.