中国骨伤2025，Vol.38Issue(9)：937-944,8.DOI:10.12200/j.issn.1003-0034.20250053
膜诱导技术结合腓肠肌肌瓣转位术治疗胫骨上段创伤性骨髓炎的临床研究
Clinical study on the treatment of traumatic osteomyelitis of the upper tibia by membrane-induced technique com-bined with gastrocnemius muscle flap transposition
摘要
Abstract
Objective To explore clinical efficacy of membrane-induced technique combined with gastrocnemius muscle flap transposition in treating traumatic osteomyelitis of the upper tibia.Methods A retrospective analysis was conducted on 7 patients with traumatic osteomyelitis of the upper tibia who were treated with membrane-induced technique combined with gastrocnemius muscle flap transposition from January 2022 to December 2023.Among them,there were 4 males and 3 fe-males;aged from 29 to 57 years old;4 patients were treated after open fracture,2 patients were treated after closed fracture,and 1 patient was treated after scalding;the courses of disease ranges from 2 weeks to 8 years;sinus tracts were present in all patients,and the lesion range of the tibia ranged from 5 to 9 cm.The results of deep tissue bacterial culture showed that 2 pa-tients were negative,3 patients were staphylococcus aureus,1 patient was methicillin-resistant staphylococcus aureus,and 1 patient was pseudomonas aeruginosa and 1 patient was klebsiella pneumoniae.After debridement,the range of bone defect ranged from 8 to 12 cm,and the cortical defect accounted for approximately 30％of the circumference.The area of soft tissue defect ranged from 8.0 cm×2.0 cm to 10.0 cm×6.0 cm.At the first stage,vancomycin-loaded/meropenem/gentamicin-loaded bone cement was implanted.The gastrocnemius muscle flap was repositioned to cover the wound surface and free skin grafting was performed.After an interval of 7 to 10 weeks,the stage Ⅱ surgery was performed to remove bone cement.Autologous iliac bone mixed with vancomycin/gentamicin and calcium sulfate artificial bone was transplanted,and the wound was sutured.One patient retained the original internal plants,one patient removed the internal plants and replaced them with steel plate external fixation,one patient replaced the internal plants and added steel plate external fixation,and three patients were simply fixed with steel plate external fixation.One year after operation,the recovery of knee joint and ankle joint functions was evaluated by using Hospital for Special Surgery(HSS)knee joint score and Kofoed ankle joint function score respectively.Results All pa-tients had their wounds closed simultaneously with bone cement implantation and healed well.All patients were followed up for 12 to 17 months after operation,and satisfactory bone healing was achieved at 6 months after stage Ⅱ surgery.Twelve months after operation,all patients had good bone healing without obvious limping was observed when walking.At 12 months after op-eration HSS knee joint score ranged from 93 to 100 points,and Kofoed ankle function score ranged from 96 to 100 points.Con-clusion For traumatic osteomyelitis of the upper tibia,a staged treatment plan combining membrane-induced technique and gastrocnemius flap transposition on the basis of thorough debridement could safely cover the wound surface,effectively control bone infection and achieve satisfactory bone healing,without adverse effects on limb function.关键词
胫骨/创伤性骨髓炎/膜诱导技术/腓肠肌/显微外科手术Key words
Tibia/Traumatic osteomyelitis/Membrane-induced technology/Gastrocnemius muscle/Micro-surgery分类
医药卫生引用本文复制引用
刘亦杨,卢一航,陈琼琳,林炳远,任海勇,黄凯,张扬,郭峭峰..膜诱导技术结合腓肠肌肌瓣转位术治疗胫骨上段创伤性骨髓炎的临床研究[J].中国骨伤,2025,38(9):937-944,8.基金项目
国家自然科学基金(编号:82474240) （编号:82474240）
浙江省中医药科技计划项目(编号:2021ZB060,2024ZL030) （编号:2021ZB060,2024ZL030）
浙江省中医药优秀青年人才基金项目(编号:2022ZQ025) （编号:2022ZQ025）
浙江省卫生科技计划青年创新人才项目(编号:2022RC017)National Natural Science Foundation of China(No.82474240) （编号:2022RC017）
