远端蒂腓肠皮瓣治疗下肢骨髓炎伴皮肤软组织缺损的疗效

The efficacy of distally based sural flap in the treatment of traumatic osteomyelitis with soft tissue defects in lower extremity

摘要:

[目的] 探讨远端蒂腓肠皮瓣治疗下肢（胫腓骨中下段及足部）创伤性骨髓炎伴皮肤软组织缺损的疗效，并分析骨髓炎复发的影响因素。[方法] 2003年11月至2021年2月，应用远端蒂腓肠皮瓣对174例伴有皮肤软组织缺损的胫腓骨中下段及足部创伤性骨髓炎患者进行治疗；采用单项因素比较与二元多因素逻辑回归分析骨髓炎复发的影响因素；根据改良ASAMI评分系统进行患肢功能评定。[结果] 174例皮瓣中，部分坏死12例（6.9%）；完全成活162例（93.1%）；骨髓炎复发22例，占12.6%。骨髓炎控制组和复发组在性别构成、骨髓炎部位、骨髓炎解剖分型、骨折情况、皮瓣近端位置、皮瓣结果的差异均无统计学意义（P＞0.05）。患者年龄是否≥40岁，骨髓炎病程是否≥10周，其骨髓炎复发率差异具有统计学意义（P<0.05）。逻辑回归分析显示：年龄≥40岁和骨髓炎解剖分型IV型是骨髓炎复发的独立危险因素。患肢功能优良率为90.2%。[结论] 远端蒂腓肠皮瓣结合恰当的骨髓炎处理，是治疗伴皮肤软组织缺损的胫腓骨中下段及足部创伤性骨髓炎的一种有效和较好的方法；该疗法骨髓炎复发率与骨髓炎Cierny-Mader解剖分型及患者年龄密切相关。

Abstract:

[Objective] This article is to investigate the efficacy of distally based sural flap in the treatment of traumatic osteomyelitis with soft tissue defects in the middle and lower tibiofibula and feet, and explore the influencing factors of osteomyelitis recurrence . [Methods] From November 2003 to February 2021, traumatic osteomyelitis with soft tissue defects in the middle and lower tibiofibula and feet in 174 patients were repaired with the distally based sural flap in our department. Univariate comparison and binary multiple logistic regression analysis were conducted to explore the influencing factors of recurrence of osteomyelitis. The function of the affected limb was assessed based on the modified ASAMI scoring system. [Results] Among 174 limbs, partial necrosis of the flap occurred in 12 limbs (6.9%), while completely survival flaps were achieved in 162 limbs (93.1%). Recurrence of osteomyelitis occurred in 22 limbs, accounted for 12.6%. In term of univariate comparison, there were no significant differences in gender composition, site and anatomical classification of osteomyelitis, fracture condition, proximal position and results of flap between the two groups (P>0.05). The recurrence rate of osteomyelitis showed the association with patients aged≥40 years and disease course of≥10 weeks, which was statistically significant (P<0.05). As results of logistic regression analysis, both the age≥40 years old and anatomical classification type IV of osteomyelitis were independent risk factors for recurrence of osteomyelitis. The functional excellence of affected limbs was 90.2%. [Conclusion] The combination of distally based sural flap and appropriate osteomyelitis treatments represents an effective and superior approach for managing traumatic osteomyelitis with s soft tissue defects in the middle and lower tibiofibula and feet. The recurrence rate of osteomyelitis is closely associated with the anatomical classification of osteomyelitis according to Cierny-Mader system as well as patient age.