Surgery for osteomyelitis of sternum and costal chondritis due to thoracotomy
MA XianJie, HAN Yan, XIA Wei, GUO ShuZhong
Plastic Surgery Center, Xijing Hospital, Fourth Military Medical University, Xian 710033, China
【Abstract】 AIM: To explore the surgical treatment for osteomyelitis of sternum and costal chondritis due to thoracotomy. METHODS: For those with chondritis of a single rib, the involved costal cartilage was directly cut from the obvious pressure pain spot. For those with chondritis of many ribs, the involved ribs were cut from the scar of thoracotomy. For those with osteomyelitis of sternum and chondritis, secreta was cultured, drug sensitive test was performed, and sinus contrast examination was done to determine the range involved before the operation. In the operation, the sternum and cartilage involved were cut and the back of the sternum was also inspected to clear the soft tissues infected. On the opposite side of the chest, musculocutaneous flaps from the great pectoral muscles were transferred to the cutoff part of the sternum. After the operation, instillation and drainage should be performed and sensitive antibiotics should be administered. RESULTS: All of the 17 patients were satisfactorily treated and the wounds healed three weeks after the operation. CONCLUSION: Cutoff of the infected costal cartilages is an effective way in the treatment of costal chondritis and the transfer of musculocutaneous flaps from the great pectoral muscles is an effective way to repair osteomyelitis of the sternum due to thoracotomy.
【Keywords】 sternum; tietze synalrome; osteomyelitis; surgical procedures, operative
【摘要】 目的： 探讨开胸术后胸骨骨髓炎、肋软骨炎的治疗方法. 方法： 对单根的肋软骨炎，在压痛最明显处直接切除受累的肋软骨;对多根肋软骨炎，可在胸部正中（开胸之瘢痕处）切开，切除受累的肋软骨；对胸骨骨髓炎伴肋软骨炎者，术前先行分泌物培养＋药敏，并行胸骨处窦道造影，确定其范围，术中应彻底清创，切除感染的胸骨及肋软骨，并向胸骨后探查，清除感染的软组织；应用胸大肌肌瓣转移填塞胸骨缺损处，术后行滴注引流，应用敏感抗生素. 结果： 本组17例，3 wk后伤口愈合，效果良好. 结论： 彻底清除感染的肋软骨是治疗开胸术后肋软骨炎的有效方法. 胸大肌肌瓣转移是治疗胸骨骨髓炎较好的方法.
【关键词】 胸骨；Tietzes综合征；骨髓炎；外科手术
0引言
开胸术后肋软骨炎、胸骨骨髓炎在临床上时有所见，肋软骨炎患者疼痛难忍，十分痛苦，虽服用镇痛药物，局部封闭有一定效果，但药物过后，症状如前，严重影响患者的工作与生活. 胸骨骨髓炎，患者伤口经久不愈，不能正常生活，临床处理困难，如迁延不愈，常并发肋软骨炎. 我科采用清创、感染肋软骨切除治疗肋软骨炎；局部肌瓣转移治疗开胸术后胸骨骨髓炎并肋软骨炎，效果良好，报告如下.
1对象和方法
1.1对象本组17（男13，女4）例，年龄40～65岁，病史3～7 mo，单纯肋软骨炎5例，肋软骨炎伴胸锁关节炎2例，胸骨骨髓炎伴肋软骨炎4例，胸骨骨髓炎6例. 11例肋软骨炎者累及1根肋软骨2例，余均累及多根肋软骨，最多累及8根肋软骨. 经清创，将感染的肋软骨切除. 对胸骨骨髓炎者，则采用局部肌瓣转移填塞修复胸骨缺损处，术后滴注引流，伤口愈合，症状消失.
1.2方法
1.2.1单根的肋软骨炎仅在压痛最显著处切开皮肤、皮下直达受累的肋软骨，将增生明显的肋软骨膜切开，可见少量稀薄脓性液体流出，同时见受累肋软骨部分与软骨膜脱离，软骨呈虫噬状，近胸骨端较重，近肋骨端较轻或未受累，向胸骨及肋骨处追踪，将受累之肋软骨完全切除，切除后，用30 mL/L双氧水，甲哨唑溶液反复冲洗，置滴注引流管，关闭伤口.
1.2.2多根受累的肋软骨炎在胸部正中开胸之疤痕处，纵形切除胸部瘢痕，在深筋膜下层广泛剥离形成一侧