腓肠肌肌瓣转移治疗髌骨内固定术后感染
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摘要
目的:探讨应用腓肠肌肌瓣治疗髌骨内固定术后感染的临床疗效。方法:自2011年1月至2017年1月收治髌骨内固定术后感染患者15例,其中男9例,女6例;年龄31～66(42.5±11.2)岁;病程2～8(4.3±1.5)个月。全部病例在病灶清除后应用腓肠肌肌瓣修复创面,肌瓣表面行游离植皮,供区直接缝合。术后观察肌瓣存活及切口愈合情况,术后9个月采用黄永新等的皮瓣疗效标准和膝关节学会评分系统(KSS)进行膝关节功能评定。结果:所有肌瓣顺利成活,无坏死。切口Ⅰ期愈合13例,术后裂开2例,经换药治疗后愈合。15例获得随访,时间9～30(20.6±8.3)个月。术后感染无复发,肌瓣质地好,皮肤色泽与受区相似,外形良好。参考黄永新等的皮瓣疗效标准,优13例,良2例。术后9个月KSS膝关节功能评分,其中临床评分为83.3±7.8,功能评分为86.3±10.4。结论:应用腓肠肌肌瓣转移治疗髌骨内固定术后感染,疗效稳定,复发率低,值得临床推广应用。
Objective:To investigate clinical effect of gastrocnemius muscle flap for repairing postoperative infection of patellar internal fixation. Methods:From January 2011 to January 2017,15 patients with postoperative infection of patellar internal fixation were treated,including 9 males and 6 females ranged from 31 to 66 years old with an average age of(42.5 ±11.2) years old. The courses of disease ranged from 2 to 8 months with an average of(4.3±1.5) months. All wounds were repaired by gastrocnemius muscle flap after debridement. The coverage of muscle flap was performed by free skin graft and donor site was closed directly. Survival of muscle flap,healing of incision were observed. HUANG Yong-xin clinical criteria and KSS score criteria were used to evaluate knee joint function 9 after operation. Results:All muscle flaps were survived without necrosis. Incision of 13 patients were healed at stage Ⅰ,and 2 patients had wound dehiscence after operation and healed after symptomatic treatment. All patients were followed up from 9 months to 30 months with an average of(20.6±8.3) months. No recurrence of infection was observed,and texture of muscle flap,skin color,appearance were good. According to HUANG Yong-xin clinical criteria,13 excellent and 2 moderate. The clinical score of KSS score was 83.3 ±7.8,and functional score of KSS score was 86.3 ±10.4. Conclusion:Gastrocnemius muscle flap is an effective method in repairing postoperative infection of patellar internal fixation with stable curative effect and low recurrence rate,which is worthy popularizing.
Objective:To investigate clinical effect of gastrocnemius muscle flap for repairing postoperative infection of patellar internal fixation. Methods:From January 2011 to January 2017,15 patients with postoperative infection of patellar internal fixation were treated,including 9 males and 6 females ranged from 31 to 66 years old with an average age of(42.5 ±11.2) years old. The courses of disease ranged from 2 to 8 months with an average of(4.3±1.5) months. All wounds were repaired by gastrocnemius muscle flap after debridement. The coverage of muscle flap was performed by free skin graft and donor site was closed directly. Survival of muscle flap,healing of incision were observed. HUANG Yong-xin clinical criteria and KSS score criteria were used to evaluate knee joint function 9 after operation. Results:All muscle flaps were survived without necrosis. Incision of 13 patients were healed at stage Ⅰ,and 2 patients had wound dehiscence after operation and healed after symptomatic treatment. All patients were followed up from 9 months to 30 months with an average of(20.6±8.3) months. No recurrence of infection was observed,and texture of muscle flap,skin color,appearance were good. According to HUANG Yong-xin clinical criteria,13 excellent and 2 moderate. The clinical score of KSS score was 83.3 ±7.8,and functional score of KSS score was 86.3 ±10.4. Conclusion:Gastrocnemius muscle flap is an effective method in repairing postoperative infection of patellar internal fixation with stable curative effect and low recurrence rate,which is worthy popularizing.
引文
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[10]商冠宁,孙平,王玉名,等.腓肠肌肌皮瓣在修复膝关节周围软组织肉瘤手术组织缺损中的应用[J].中国肿瘤外科杂志,2013,5(1):23-26.SHANG GN,SUN P,WANG YM,et al.Gastrocnemius muscle flap for repair the defects of soft tissue sarcoma at the knee[J].Zhongguo Zhong Liu Wai Ke Za Zhi,2013,5(1):23-26.Chinese.
[11]Daigeler A,Drucke D,Tatar K,et al.The pedicled gastrocnemius muscle flap:a review of 218 cases[J].Plast Reconstr Surg,2009,123(1):250-257.
[12]黄凯,郭峭峰,林炳远,等.腓肠肌肌瓣联合植皮一期治疗人工全膝关节置换术后皮肤坏死[J].中华显微外科杂志,2017,40(3):287-289.HUANG K,GUO QF,LIN BY,et al.Gastrocnemius muscle flap combined with skin grafting for the treatment of skin necrosis after total knee arthroplasty[J].Zhonghua Xian Wei Wai Ke Za Zhi,2017,40(3):287-289.Chinese.
[13]Jepegnanam TS,Boopalan PR,Nithyananth M,et al.Reconstruction of complete knee extensor mechanism loss with gastrocnemius flaps[J].Clin Orthop,2009,467(10):2662-2667.
[14]江彬锋,黄凯,陆建伟,等.髂骨及载抗生素人工骨联合腓肠肌内侧头肌皮瓣移植治疗胫骨中上段创伤性骨髓炎[J].中华整形外科杂志,2017,33(3):226-227.JIANG BF,HUANG K,LU JW,et al.Iliac bone and antibiotic loaded artificial bone combined with medial gastrocnemius myocutaneous flap transplantation for the treatment of traumatic osteomyelitis of middle and upper tibia[J].Zhonghua Zheng Xing Wai Ke Za Zhi,2017,33(3):226-227.Chinese.
[15]林炳远,郭峭峰,黄凯,等.外固定支架骨转移技术治疗股骨干骨髓炎大段骨缺损[J].中国骨伤,2015,28(9):850-853.LIN BY,GUO QF,HUANG K,et al.Treatment of osteomyelitis and bone defect of femoral shaft by external fixation and bone transport[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(9):850-853.Chinese with abstract in English.
[16]彭冰,宋才渊,金红婷,等.慢性骨髓炎的临床诊断与治疗[J].中国骨伤,2015,28(9):870-873.PENG B,SONG CY,JIN HT,et al.Clinical diagnosis and treatment of chronic osteomyelitis[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(9):870-873.Chinese with abstract in English.
[17]顾祥,王世界,何仕诚,等.负压与关节腔内灌洗引流治疗髌骨骨折术后感染的临床分析[J].中华医院感染学杂志,2013,23(22):5441-5443.GU X,WANG SJ,HE SC,et al.Clinical efficacy of vacuum sealing drainage combined with intra articular lavage in treatment of infections after patella fracture surgery[J].Zhonghua Yi Yuan Gan Ran Xue Za Zhi,2013,23(22):5441-5443.Chinese.
[2]Chim H,Tan BK,Tan MH,et al.Optimizing the use local muscle flaps for knee megaprosthesis coverage[J].Ann Plast Surg,2007,59(4):398-403.
[3]黄永新,詹新华,朱剑仙,等.隐神经-大隐静脉营养血管与胫后动脉皮支蒂联合皮瓣修复足部慢性溃疡创面[J].中华医学美学美容杂志,2011,17(4):254-256.HUANG YX,ZHAN XH,ZHU JX,et al.Application of combined saphenous nerve great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repair of chronic ulcer in foot[J].Zhonghua Yi Xue Mei Xue Mei Rong Za Zhi,2011,17(4):254-256.Chinese.
[4]Insall JN,Dorr LD,Scott RD.Rationale of the knee society clinical rating system[J].Clin Orthop,1989,(248):13-14.
[5]张玉富,田鹏,王满宜,等.负压封闭引流技术结合关节腔内灌洗引流治疗髌骨骨折术后感染[J].中华创伤骨科杂志,2013,12(4):125-126.ZHANG YF,TIAN P,WANG MY,et al.Application of vacuum sealing drainage and closed irrigation suction to manage infection after patellar facture surgery[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2013,12(4):125-126.Chinese.
[6]Voon V,Arshad H,Davis B.Patella distal pole avulsion secondary to osteomyelitis in a healthy adult[J].Ann R Coll Surg Engl,2013,93(3):58-59.
[7]Anand S,Hahnel JC,Giannoudis PV.Open patellar fracture:high energy injuries with a poor outcome[J].Injury,2008,39(4):480-484.
[8]Moscona RA,Fodor L,Har Shai Y.The segmental gastrocnemius muscle flap:anatomical study and clinical applications[J].Plast Reconstr Surg,2006,118(5):1178-1182.
[9]Veber M,Vaz G,Braye F,et al.Anatomical study of the medial gastrocnemius muscle flap:a quantitative assessment of the arc of rotation[J].Plast Reconstr Surg,2011,128(1):181-187.
[10]商冠宁,孙平,王玉名,等.腓肠肌肌皮瓣在修复膝关节周围软组织肉瘤手术组织缺损中的应用[J].中国肿瘤外科杂志,2013,5(1):23-26.SHANG GN,SUN P,WANG YM,et al.Gastrocnemius muscle flap for repair the defects of soft tissue sarcoma at the knee[J].Zhongguo Zhong Liu Wai Ke Za Zhi,2013,5(1):23-26.Chinese.
[11]Daigeler A,Drucke D,Tatar K,et al.The pedicled gastrocnemius muscle flap:a review of 218 cases[J].Plast Reconstr Surg,2009,123(1):250-257.
[12]黄凯,郭峭峰,林炳远,等.腓肠肌肌瓣联合植皮一期治疗人工全膝关节置换术后皮肤坏死[J].中华显微外科杂志,2017,40(3):287-289.HUANG K,GUO QF,LIN BY,et al.Gastrocnemius muscle flap combined with skin grafting for the treatment of skin necrosis after total knee arthroplasty[J].Zhonghua Xian Wei Wai Ke Za Zhi,2017,40(3):287-289.Chinese.
[13]Jepegnanam TS,Boopalan PR,Nithyananth M,et al.Reconstruction of complete knee extensor mechanism loss with gastrocnemius flaps[J].Clin Orthop,2009,467(10):2662-2667.
[14]江彬锋,黄凯,陆建伟,等.髂骨及载抗生素人工骨联合腓肠肌内侧头肌皮瓣移植治疗胫骨中上段创伤性骨髓炎[J].中华整形外科杂志,2017,33(3):226-227.JIANG BF,HUANG K,LU JW,et al.Iliac bone and antibiotic loaded artificial bone combined with medial gastrocnemius myocutaneous flap transplantation for the treatment of traumatic osteomyelitis of middle and upper tibia[J].Zhonghua Zheng Xing Wai Ke Za Zhi,2017,33(3):226-227.Chinese.
[15]林炳远,郭峭峰,黄凯,等.外固定支架骨转移技术治疗股骨干骨髓炎大段骨缺损[J].中国骨伤,2015,28(9):850-853.LIN BY,GUO QF,HUANG K,et al.Treatment of osteomyelitis and bone defect of femoral shaft by external fixation and bone transport[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(9):850-853.Chinese with abstract in English.
[16]彭冰,宋才渊,金红婷,等.慢性骨髓炎的临床诊断与治疗[J].中国骨伤,2015,28(9):870-873.PENG B,SONG CY,JIN HT,et al.Clinical diagnosis and treatment of chronic osteomyelitis[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(9):870-873.Chinese with abstract in English.
[17]顾祥,王世界,何仕诚,等.负压与关节腔内灌洗引流治疗髌骨骨折术后感染的临床分析[J].中华医院感染学杂志,2013,23(22):5441-5443.GU X,WANG SJ,HE SC,et al.Clinical efficacy of vacuum sealing drainage combined with intra articular lavage in treatment of infections after patella fracture surgery[J].Zhonghua Yi Yuan Gan Ran Xue Za Zhi,2013,23(22):5441-5443.Chinese.