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[1]任飛龍,郭俊,周大鵬,等.膜誘導(dǎo)技術(shù)治療成人創(chuàng)傷后骨髓炎[J].中醫(yī)正骨,2017,29(11):50-54.
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膜誘導(dǎo)技術(shù)治療成人創(chuàng)傷后骨髓炎()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年11期
頁碼:
50-54
欄目:
學(xué)術(shù)探討
出版日期:
2017-11-20

文章信息/Info

作者:
任飛龍; 郭俊; 周大鵬; 陳語
中國人民解放軍沈陽軍區(qū)總醫(yī)院,遼寧 沈陽 110801
關(guān)鍵詞:
骨髓炎;  骨缺損;  膜誘導(dǎo)技術(shù)
摘要:
目的:探討膜誘導(dǎo)技術(shù)治療成人創(chuàng)傷后骨髓炎的臨床療效和安全性。方法:2013年3月至2016年4月,采用膜誘導(dǎo)技術(shù)治療成人創(chuàng)傷后骨髓炎患者35例,男30例、女5例; 年齡19～70歲,中位數(shù)39歲; 脛骨16例,股骨17例,尺骨2例; 均于傷后急診行開放性骨折清創(chuàng)探查、抗生素鏈珠植入、負(fù)壓封閉引流技術(shù)及外固定架固定術(shù),術(shù)后出現(xiàn)紅腫熱痛等表現(xiàn); 負(fù)壓引流管均引出膿性分泌物,細(xì)菌培養(yǎng)均為陽性,其中金黃色葡萄球菌16例、大腸桿菌4例、草綠色鏈球菌3例、鮑曼不動(dòng)桿菌4例、混合性細(xì)菌感染8例。病程5～9個(gè)月,中位數(shù)7個(gè)月。隨訪觀察骨愈合、患肢功能恢復(fù)、患者生存質(zhì)量及并發(fā)癥發(fā)生情況。結(jié)果:所有患者均獲隨訪,隨訪時(shí)間13～48個(gè)月,中位數(shù)21個(gè)月。31例患者獲得一期骨愈合,愈合時(shí)間4～9個(gè)月,中位數(shù)6個(gè)月; 1例出現(xiàn)骨缺損處感染, 再次行膜誘導(dǎo)手術(shù)后骨愈合; 2例出現(xiàn)二期植骨吸收,再次行徹底清創(chuàng)植骨術(shù)后骨愈合; 1例出現(xiàn)皮瓣壞死和骨缺損處感染,再次行皮瓣修復(fù)術(shù)、膜誘導(dǎo)手術(shù)及積極抗感染治療后皮瓣成活、骨愈合。2例出現(xiàn)髂骨切口處感染,經(jīng)清創(chuàng)后感染得到控制; 其余患者無明顯并發(fā)癥發(fā)生。末次隨訪時(shí),28例患肢恢復(fù)良好,可正常負(fù)重行走; 3例出現(xiàn)下肢短縮,分別短縮0.8 cm、1.5 cm和1 cm,但不影響行走; 4例患肢出現(xiàn)輕微畸形愈合,但不影響正常活動(dòng); SF-36健康調(diào)查量表總評(píng)分由術(shù)前(51.22±9.28)分升高至(73.30±9.18)分。結(jié)論:采用膜誘導(dǎo)技術(shù)治療成人創(chuàng)傷后骨髓炎,操作簡單,能促進(jìn)骨愈合,有利于患肢功能恢復(fù),改善患者生存質(zhì)量,并發(fā)癥較少,值得臨床推廣應(yīng)用。

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更新日期/Last Update: 2018-04-02