Clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis
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摘要:
目的 探讨应用en bloc切除清创联合臀大肌肌瓣在坐骨结节压疮合并慢性骨髓炎治疗中的临床效果。 方法 采用回顾性观察性研究方法。2018年5月—2020年2月，阜阳民生医院收治8例符合入选标准的坐骨结节压疮合并慢性骨髓炎患者，其中男5例、女3例；年龄38~69岁；病灶累及单侧者6例、双侧者2例；根据Cierny-Mader骨髓炎解剖部位分型，局灶型者6例（7侧）、弥散型者2例（3侧）；入院时创面面积为3 cm×2 cm~12 cm×9 cm。采用en bloc切除清创将压疮和慢性骨髓炎病灶组织彻底清除，一期将慢性感染性病灶转变为无菌切口样的新鲜创面，切取面积为10 cm×6 cm~15 cm×9 cm的臀大肌肌瓣转移填塞无效腔。将5例患者创面直接缝合，3例患者创面通过局部皮瓣转移闭合。记录患者术中出血量和输血情况、住院时间，术后观察患者切口愈合及皮瓣存活情况，随访观察患者压疮及骨髓炎复发情况、患部外观、肌瓣供区继发功能障碍和畸形情况。 结果 8例患者术中出血量为220~900（430±150）mL；5例患者进行了术中输血治疗，其中2例患者输入3 U悬浮红细胞、3例患者输入2U悬浮红细胞；8例患者住院时间为18~29（23.5±2.0）d。7例患者切口愈合；1例患者翻身过程中切口缝线撕脱，进行二次缝合后愈合。3例进行局部皮瓣转移患者术后皮瓣存活良好。随访6~20个月，8例患者压疮和骨髓炎均未复发，患处皮肤质地良好、轻度色素沉着、无窦道形成，供区均未继发功能障碍或畸形。 结论 应用en bloc切除清创联合臀大肌肌瓣治疗坐骨结节压疮合并慢性骨髓炎的临床效果较佳，术后压疮和骨髓炎未复发，患处皮肤质地和外观良好，供区未继发功能障碍或畸形。 -
关键词:
- 压力性溃疡 /
- 骨髓炎 /
- 坐骨 /
- En bloc切除清创 /
- 肌瓣
Abstract:Objective To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity. -
Key words:
- Pressure ulcer /
- Osteomyelitis /
- Ischium /
- En bloc resection and debridement /
- Muscle flap
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参考文献
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1 En bloc切除清创联合臀大肌肌瓣治疗例1患者左侧坐骨结节压疮合并慢性骨髓炎。1A.术前创面情况及肌瓣设计；1B.术前CT示坐骨骨质破坏，游离死骨形成（红圈处）；1C.术前CT示骨髓炎病灶脓腔（红圈处）；1D.采用en bloc切除清创后遗留的无效腔；1E.切取的臀大肌肌瓣；1F.将肌瓣转位填塞无效腔；1G.术后创面闭合即刻；1H.术后1年随访，患处轻度色素沉着、无窦道形成
2 En bloc切除清创联合臀大肌肌瓣治疗例2患者双侧坐骨结节压疮合并慢性骨髓炎。2A.术前创面情况及肌瓣设计；2B.术前CT示左侧骨髓炎病灶（红圈处）；2C.术前CT示右侧骨髓炎病灶（红圈处）；2D. CT示左侧骨髓炎病灶巨大脓腔形成（红圈处）；2E.采用en bloc切除清创后遗留的无效腔；2F.切除的病灶囊壁组织；2G.术后创面闭合即刻；2H.术后8个月随访，患处皮肤轻度色素沉着、无窦道形成，供区未继发畸形
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