脊柱后路内固定术后切口愈合不良的整形外科治疗

doi:10.19723/j.issn.1671-167X.2023.05.020

摘要/Abstract

摘要：

目的: 探讨不同整形外科治疗方案在脊柱后路内固定术后切口愈合不良中的临床意义。方法: 回顾性纳入16例脊柱后路内固定术后切口愈合不良患者, 根据创面特征及缺损情况决定不同整形外科治疗方案, 包括清创、创面密闭式负压吸引(vacuum sealing drainage, VSD)、根据创面缺损部位及程度设计不同组织皮瓣覆盖等。结果: 共纳入符合标准的患者16例, 其中3例使用清创联合VSD治疗后创面直接缝合, 6例使用清创联合Z皮瓣修复创面, 1例使用双侧骶棘肌肌瓣修补硬脊膜缺损联合Z皮瓣修复皮肤创面, 1例使用背阔肌皮瓣修复创面, 3例使用第四腰动脉穿支皮瓣修复创面, 1例使用局部旋转皮瓣修复创面, 1例使用臀大肌肌皮瓣修复创面。16例患者中, 有7例创面细菌培养阳性, 其中3例为金黄色葡萄球菌, 1例铜绿假单胞杆菌, 1例表皮葡萄球菌, 1例大肠埃希菌, 1例肺炎克雷波杆菌, 其余9例创面细菌培养均为阴性。术后有7例患者出现创面不同程度愈合不良, 其中3例进行换药治疗, 2例进行二次清创缝合, 1例采用头皮游离皮片移植, 1例进行局部积液抽吸, 以上7例患者均好转出院, 其余9例患者手术后创面均一期愈合良好。16例患者均未行内固定取出。结论: 多种因素可以导致脊柱后路内固定术后切口愈合不良, 早期干预、彻底清创、去除坏死/感染组织、选择合适的皮瓣有效创面填充覆盖是保证脊柱术后创面愈合、减少内固定取出的重要手段。

关键词: 脊柱后路内固定手术, 切口愈合不良, 整形外科手术, 组织皮瓣移植

Abstract:

Objective: To investigate the clinical significance of different plastic surgeries in the treatment of poor healing wound after posterior spinal internal fixation. Methods: In this study, 16 patients with poor incision healing after posterior spinal internal fixation were retrospectively included, and dif-ferent plastic surgery treatment plans were determined according to the wound characteristics and defect condition. The measures included debridement, vacuum sealing drainage (VSD), and different tissue flaps according to the location and extent of the defect. Results: A total of 16 patients meeting the criteria were included, of whom 3 were treated with debridement combined with VSD and wound suture directly, 6 were treated with debridement combined with Z-flap for wound repair, 1 was treated with bilateral sacrospinous muscle flap for dural defect repair combined with Z-flap for skin wound repair, 1 was treated with lectus dorsi flap for wound repair, 3 were treated with the fourth lumbar artery perforator flap for wound repair. The wound was repaired with local rotating flap in 1 case and gluteus maximus musculocutaneous flap in 1 case. Among the 16 patients, 7 cases were positive for wound culture, including 3 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, 1 case of Staphylococcus epidermidis, 1 case of Escherichia coli, 1 case of Klebsiella pneumoniae, and the other 9 cases were negative. After surgery, there were 7 patients with different degrees of poor wound healing, including 3 patients undergoing dressing change, 2 patients undergoing secondary debridement and suture, 1 patient undergoing free scalp skin graft, and 1 patient undergoing local effusion suction treatment. All the above 7 patients were discharged from hospital after improvement, and the remaining 9 patients had good first-stage wound hea-ling after surgery. None of the 16 patients underwent internal fixation. Conclusion: Multiple factors could lead to poor wound healing after posterior spinal internal fixation. Early intervention, thorough debridement, removal of necrotic/infected tissue, and selection of suitable skin flap for effective wound fil-ling and covering were important means to ensure wound healing after spinal surgery and reduce removal of internal fixation.

Key words: Posterior spinal internal fixation, Non-healing wound, Plastic and reconstruction surgery, Flap reconstruction

中图分类号:

R622.1

张心灵,林志禹,陈玉杰,董文芳,杨欣. 脊柱后路内固定术后切口愈合不良的整形外科治疗[J]. 北京大学学报（医学版）, 2023, 55(5): 910-914.

Xin-ling ZHANG,Zhi-yu LIN,Yu-jie CHEN,Wen-fang DONG,Xin YANG. Plastic and reconstruction surgery for non-healing wound after posterior spinal surgery[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 910-914.

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