远端蒂腓肠皮瓣治疗踝周皮肤缺损骨髓炎的影响因素△

Factors impacting distally based sural flap for middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect

摘要:

[目的]探讨远端蒂腓肠皮瓣治疗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—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。根据改良 ASAMI 评分系统进行患肢功能评定。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。[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（12.6%），治愈组 152 例 （87.4%）。末次随访时依据改良 ASAMI 评分，优 74 例 （42.5%），良 83 例 （47.7%），可 14 例 （8.0%） 和差 3 例 （1.7%），总体优良率为 90.2%。单项因素比较表明，复发组与治愈组在性别构成、病灶部位、骨髓炎解剖分型、皮瓣面积和骨折处理情况的差异无统计学意义（P＞0.05）。但是，复发组患者年龄、病程均显著大于治愈组（P＜0.05）。逻辑回归分析显示：患者年龄大（OR=1.024, P=0.046）、病程长（OR=4.664, P=0.004）和骨髓炎 Cierny-Mader IV 分型重（OR=4.086, P=0.041）是骨髓炎复发的独立危险因素。[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 分型、病程及患者年龄密切相关。

Abstract:

[Objective] To investigate the efficacy of distally based sural flap (DBSF) for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect, and to analyze the factors affecting the recurrence of osteomyelitis. [Methods] A total of 174 patients received DBSF for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect from November 2003 to February 2021. The function of the affected limb was evaluated according to the modified Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. The factors influencing the recurrence of osteomyelitis were analyzed by univariate comparison and binary multifactor logistic regression. [Results] Of 174 patients, 12 cases (6.9%) got partially necrotic flap, while 162 cases (93.1%) had completely alive flap. On other hand, 22 cases (12.6%) had osteomyelitis recurred, whereas 152 cases (87.4%) got primarily cured. According to the modified ASAMI criteria, 74 cases (42.5%) were excellent, 83 cases (47.7%) were good, 14 cases (8.0%) were fair, and 3 cases (1.7%) were poor, with an overall excellent and good rate of 90.2% at the last follow-up. Regarding univariate comparison, there were no significant differences in gender composition, lesion location, anatomic classification of osteomyelitis, flap area and fracture management between the recurrence group and the cure group (P＞0.05). However, the recurrence group proved significantly greater than the cure group in age and course of disease (P＜0.05). As consequence of logistic regression, the old age (OR=1.024, P=0.046), long course of disease (OR=4.664, P=0.004) and severe Cierny-Mader IV classification (OR=4.086, P=0.041) were independent risk factors for osteomyelitis recurrence. [Conclusion] Distally based sural flap combined with appropriate osteomyelitis treatment is an effective method for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect. The recurrence rate of osteomyelitis is closely related to Cierny-Mader classification, course of disease and age of patients.