摘要
目的应用游离前锯肌瓣移植治疗跟骨骨髓炎，并评价其疗效。方法2000年2月至2006年1月间收治13例跟骨骨髓炎患者，男9例，女4例；平均年龄36岁。跟骨骨髓炎病因：7例跟骨骨折行“L”形切口术后感染，3例开放性跟骨骨折软组织缺损，3例软组织缺损处理不当。软组织缺损面积：4．4cm×6．2cm～11．0cm×l3．0cm。所有患者采用游离前锯肌瓣移植＋植皮治疗。术中分离前锯肌动脉支，根据跟骨受区大小切取前锯肌最下方3-5个肌齿。根据术前血管造影确定采用胫前、胫后动脉或足背动脉进行动脉血管吻合，静脉与大、小隐静脉吻合或与动脉伴行静脉吻合。结果13例跟骨骨髓炎最终均治愈，无复发。平均手术时间为（6．3±1．3）h。随访时间为6个月-6年，平均38个月。l例皮肤部分坏死给予植皮后愈合，l例出现暂时性血管危象，使用尿激酶治疗后好转。本组病例术后无翼状肩胛发生，无慢性感染或窦道形成。术后6个月所有患者伤肢可负重活动。结论游离前锯肌瓣移植可填塞跟骨骨髓炎空腔、修复软组织缺损、控制感染，是治疗跟骨骨髓炎的方法之一。
Objective To explore the clinical outcome of using serratus anterior muscle flap combined with skin graft for the calcaneal osteomyelitis. Methods 13 patients diagnosed as calcaneal osteomyelitis, which included 9 males and 4 females with the an average age of 36 years, treated with free serratus anterior muscle flap combined with skin graft between February 2000 and January 2006. Seven patients had calcaneal osteomyelitis resulting from uncontrolled postoperative infection of surgical treatment of calcaneal fractures with ＂L＂ shape incision, 3 cases resulting from open calcaneal fractures with soft tissue defect, the other 3 cases resulting from improper treatment of the soft tissues in hindfoot. The soft tissue defect areas were 4.4 cm×6.2 cm-11.0 cm×13.0 cm. During the operation the serratus anterior artery was dissected and the 3-5 lower segment of the anterior serrated muscle was incised according to the exact need. The arteries in the lower limb that couM be anastomosed in .Sarratus anterior muscle flap transplantation included anterior tibial artery, posterior tibial artery or dorsal pedis artery. The vein included the greater saphenous vein, lesser saphenous vein, or the corresponding deep veins companied with the above arteries. Clinical resuits were evaluated. Results The average operation time was （6.3±1.3） h. All of the patients had been followed up for 0.5-6 years with an average of 38 months. All 13 cases had healed without recrudesce. Region skin necrosis occurred in one patient needed skin graft again. One patient who experienced circulatory crisis needed urokinase to alleviate symptoms. The shoulders of all patients moved within normal range without sign of winged scapula. There were no infection and haematoma formation in the shoulder, as well as no chronic infection and sinus formation in the hindfoot. Six months after operation, all patients could walk on the affected foot. Condusion The serratus anterior muscle flap can be used to repair the soft tissue defect of hindfoot, tamp the
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第12期I0017-I0020,共4页
Chinese Journal of Orthopaedics
关键词
骨髓炎
跟骨
外科皮瓣
感染
Osteomyelitis
Calcaneus
Surgical flap
Infection
