开胸术后胸骨骨髓炎、肋软骨炎的整形外科治疗_医学论文.docVIP

开胸术后胸骨骨髓炎、肋软骨炎的整形外科治疗_医学论文 开胸术后胸骨骨髓炎、肋软骨炎的整形外科治疗_医学论文 作者：马显杰，韩岩，夏炜，郭树忠 【关键词】 骨髓炎 　　【Abstract】 AIM: To explore the surgical treatment for osteomyelitis of sternum and costal chondritis due to thoracotomy. METHODS: For those with chondritis of a single rib, the involved costal cartilage was directly cut from the obvious pressure pain spot. For those with chondritis of many ribs, the involved ribs were cut from the scar of thoracotomy. For those with osteomyelitis of sternum and chondritis, secreta was cultured, drug sensitive test was performed, and sinus contrast examination was done to determine the range involved before the operation. In the operation, the sternum and cartilage involved were cut and the back of the sternum was also inspected to clear the soft tissues infected. On the opposite side of the chest, musculocutaneous flaps from the great pectoral muscles were transferred to the cutoff part of the sternum. After the operation, instillation and drainage should be performed and sensitive antibiotics should be administered. RESULTS: All of the 17 patients were satisfactorily treated and the wounds healed three weeks after the operation. CONCLUSION: Cutoff of the infected costal cartilages is an effective way in the treatment of costal chondritis and the transfer of musculocutaneous flaps from the great pectoral muscles is an effective way to repair osteomyelitis of the sternum due to thoracotomy. 　　【Keywords】 sternum tietze synalrome osteomyelitis surgical procedures, operative 　　【摘要】 目的： 探讨开胸术后胸骨骨髓炎、肋软骨炎的治疗方法. 方法： 对单根的肋软骨炎，在压痛最明显处直接切除受累的肋软骨对多根肋软骨炎，可在胸部正中（开胸之瘢痕处）切开，切除受累的肋软骨；对胸骨骨髓炎伴肋软骨炎者，术前先行分泌物培养＋药敏，并行胸骨处窦道造影，确定其范围，术中应彻底清创，切除感染的胸骨及肋软骨，并向胸骨后探查，清除感染的软组织；应用胸大肌肌瓣转移填塞胸骨缺损处，术后行滴注引流，应用敏感抗生素. 结果： 本组17例，3 wk后伤口愈合，效果良好. 结论： 彻底清除感染的肋软骨是治疗开胸术后肋软骨炎的有效方法. 胸大肌肌瓣转移是治疗胸骨骨髓炎较好的方法. 　　【关键词】 胸骨；Tietzes综合征；骨髓炎；外科手术 　　0引言 　　开胸术后肋软骨炎、胸骨骨髓炎在临床上时有所见，肋软骨炎患者疼痛难忍，十分痛苦，虽服用镇痛药物，局部封闭有一定效果，但药物过后，症状如前，严重影响患者的工作与生活. 胸骨骨髓炎，患者伤口经久不愈，不能正常生活，临床处理困难，如迁延不愈，常并发肋软骨炎. 我科采用清创、感染肋软骨切除治疗肋软骨炎；局部肌瓣转