应用带薄层肌肉腓肠神经营养血管皮瓣及OSTEOSET(R)T治疗胫骨骨折术后感染并骨外露.docVIP

应用带薄层肌肉腓肠神经营养血管皮瓣及OSTEOSET(R)T治疗胫骨骨折术后感染并骨外露[摘要]目的：初步总结应用带薄层肌肉的腓肠神经营养血管皮瓣及OSTEOSET T治疗胫骨骨折术后感染并骨外露的效果。方法：本组11例，男9例，女2例。年龄22～51岁，平均39岁。左侧7例，右侧4例。为开放性骨折，均存在较大面积骨外露(10～18cm2，平均12cm2)。合并骨缺损6例。手术时彻底清除病灶组织并取出内固定物，局部植入OSTEOSET T颗粒，切取逆行或顺行带薄层肌肉的腓肠神经营养血管皮瓣覆盖骨外露区。结果：本组11例均获随访，随访3～12个月，平均9个月。所有肌筋膜皮瓣均成活，无皮缘坏死，所有感染均治愈。4例切口Ⅰ期愈合，7例术后局部渗液2～6周，细菌培养无菌生长，均经局部换药后愈合。6例合并骨缺损者5例不需Ⅱ期植骨，1例经Ⅱ期植骨后修复。结论：应用带薄层肌肉的腓肠神经营养血管皮瓣及治疗胫骨骨折术后感染并骨外露，可以获得比较理想的疗效。 [关键词]皮瓣；OSTEOSET T；胫骨骨折；感染；骨外露 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2008）10-1424-03 Treament of bone infection and exposure in tibial fracture after operation withneuroadipofascial pedicled based suralnerve island myofascialcutaneous flap and OSTEOSETT XIE Wei-ning,YANG Ying-nian,WU Zu-jun (Department of Osteopathy and Bone tumour，Yulin Orthopedics Hospital,Yulin 537000,Guangxi,China) Abstract:ObjectiveTo discuss the curative effect of neuroadipofascial pedicled based suralnerve island myofascialcutaneous flap and OSTEOSETT on patients with bone infection and exposure in tibial fractur.MethodsFrom June 2005 to September 2007, 11 patients (6 cases with bone defect) with bone infection and exposure in tibial fracture were operated. All cases were open facture and with biggish area bone exposure(10～18cm2，average 12 cm2). All cases were treated by neuroadipofascial pedicled based suralnerve island myofascialcutaneous flap and OSTEOSETT after the surgery. ResultsAll the 11 cases were followed up for 3 to 12 months(average 9 months). Four cases were healing by first intention, and 7 cases were healing by second intention. One of the 6 cases with bone defect was healing by second bone graft, five of the 6 case were healing without second bone graft.ConclusionsTreament of bone infection and exposure in tibial fracture with neuroadipofascial pedicled based suralnerve island myofascialcutaneous flap and OSTEOSETTis a perfect technique. Key words: flap; OSTEOSETT; tibial fracture; infection; bone exposure 胫骨骨折术后感染并骨外露是骨科常遇到的棘手问题。如何同时取得