目的:探讨病灶清除加髓腔持续负压封闭引流对胫骨慢性骨髓炎的治疗效果.方法:2006年3月至2009年5月,采用彻底病灶清除,骨皮质开槽并髓腔内持续负压封闭引流治疗胫骨慢性骨髓炎19例,二次手术闭合创面,其中男12例,女7例；年龄25～68岁,平均39岁,均为创伤后导致的胫骨慢性骨髓炎,迁延不愈.病程10个月～5年.临床症状:局部软组织红肿、压痛、流脓,有经久不愈窦道及恶臭脓液流出.X线片示:骨质硬化,密度增高,有死骨、死腔或形成包壳.细菌培养:绿脓杆菌3例,金黄色葡萄球菌13例,产气杆菌1例,溶血性链球菌2例.其中3例为耐甲氧西林的金黄色葡萄球菌.结果:经清创、负压封闭引流18～22d,创面内芽新鲜,直接缝合创面17例,行皮瓣移位修复创面2例,创面愈合标准是创面干燥、清洁,无渗液.所有创面Ⅰ期愈合,观察6～12个月窦道无复发,X线片示骨质生长良好,没有发生骨折.结论:病灶清除加髓腔持续负压封闭引流是治疗胫骨慢性骨髓炎的一种安全、有效的方法.%Objective:To explore the therapeutic effect of debridement and vacuum sealing drainage (VSD) of cavitas medullaris for the treatment of chronic osteomyelitis of tibia. Methods: From March 2006 to May 2009,19 patients with chronic osteomyelitis of tibia were treated by debridment and VSD, then the second operation were performed to close the wound. A-mong them, 12 patients were male and 7 patients were female,the average age was 39 years (ranged from 25 to 68 years). The course of disease were from 10 months to 5 years. The main clinical symptoms were red swelling, tenderness and fluid of local soft tissue. There were prolonged unhealed sinus and pus;the X-ray showed osteosclerosis,increased bone mineral,and sequestrum and dead space was formed. The result of bacterial culture showed 3 cases were aeruginosus bacillus, 13 cases staphylococcus aureus, 1 case bacillus aerogenes and 2 cases beta streptococcus. Among them,3 cases were methicillin resistant staphylococcus(MRS). Results: After debridement and VSD of cavitas medullaris 18-22 days later, the granulation tissue grow well and the wounds of the 19 patients all healed primarily with direct suturing of Peases,loco-regional flap of 2 cases. The standard of wound healing was the dryness, cleanness and no drainage. The X-ray revealed the bone tissue grew well and no relapse and fracture occurred during followed-up 6-12 months. Conclusion: The debridement and VSD of cavitas medullaris is a very effective and safe treatment for chronic osteomyelitis of tibia.
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