摘要
目的总结颅骨慢性骨髓炎的治疗方法及其疗效。方法 2004年1月-2009年2月,收治24例颅骨慢性骨髓炎患者。男16例,女8例;年龄18～56岁,平均45.6岁。病程3～11年,平均5.8年。病因:开颅术后感染3例,烧伤15例,电击伤6例。部位:额顶部10例,颞顶部8例,枕部6例。彻底清除感染坏死组织后软组织缺损范围为7 cm×6 cm～19 cm×12 cm,颅骨缺损范围为5 cm×4 cm～10 cm×7 cm。采用邻位头皮瓣(12例)、斜方肌肌皮瓣(6例)、游离股前外侧皮瓣(6例)修复,皮瓣切取范围为8 cm×7 cm～20 cm×13 cm。供区直接缝合或中厚皮片游离移植修复。结果术中病理检查均为颅骨化脓性骨髓炎伴死骨形成,1例发现局部鳞癌。术后2周1例出现皮瓣下感染,再次手术清除残留组织后愈合;其余皮瓣及皮片均成活好,切口Ⅰ期愈合。术后患者均获随访,随访时间10个月～4年,平均2年。皮瓣颜色、质地较好,骨髓炎无复发。1例局部鳞癌患者术后随访4年未复发。8例术后3～6个月出现头痛、头晕等颅骨缺损相关症状,二期行钛网颅骨重建。结论颅骨慢性骨髓炎应早期彻底清除感染病灶,选择适宜的皮瓣或肌皮瓣修复创面,可获满意效果。
Objective To summarize the treatment of chronic osteomyelitis of the skull and its effectiveness.Methods Between January 2004 and February 2009,24 patients with chronic osteomyelitis of skull were diagnosed and treated,including 16 males and 8 females with an average age of 45.6 years（range,18-56 years）.The mean disease duration was 5.8 years（range,3-11 years）.The causes included infection after craniotomy in 3 cases,burn in 15 cases,and electrical injury in 6 cases,and the leision was located at the frontal and parietal of the skull in 10 cases,at the temporal and parietal of skull in 8 cases,and at the occipital of the skull in 6 cases.The soft tissue defects ranged from 7 cm×6 cm to 19 cm×12 cm,and the skull defects ranged from 5 cm×4 cm to 10 cm×7 cm.After wide thorough debridement of necrotic tissue,soft tissue defects were repaired with adjacent scalp flap in 12 cases,trapezius myocutaneous flap in 6 cases,and free anterolateral thigh flap in 6 cases;the flap size ranged from 8 cm×7cm to 20 cm×13 cm.The donor sites were sutured directly or covered with split-thickness skin.Results All pathological examinations showed pyogenic osteomyelitis of the skull,and localized squamous carcinoma was found in 1 case.One patient had sub-flap infection at 2 weeks after operation,and healing was achieved after surgical removal of residual tissue;the remaining flaps survived,and incision healed by first intention.All patients were followed up 10 months to 4 years with an average of 2 years after operation.The color and texture of the flaps were good.No recurrence of osteomyelitis happened during follow-up.The patient diagnosed as having localized squamous carcinoma was followed up 4 years without recurrence.At 3 to 6 months after operation,8 patients had headache or felt dizzy,and the skull was reconstructed by the titanium meshes.Conclusion In patients with chronic osteomyelitis of skull,the infected foci should be cleaned out thoroughly as early as possible,and the skin flap or myocutaneous flap is used to
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第5期558-561,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
颅骨
慢性骨髓炎
皮瓣
修复
Skull Chronic osteomyelitis Flap Repair
