摘要目的:观察应用小腿组织瓣联合载抗生素硫酸钙人工骨治疗胫骨骨髓炎的手术方法和临床疗效。方法:2018年7月至2021年1月,宝鸡第三医院手显微外科应用小腿组织瓣联合载抗生素硫酸钙人工骨（或加髂骨混合植骨）治疗胫骨骨髓炎16例。男10例,女6例；年龄15~64岁,平均41岁。对5例急性感染期创面或慢性骨髓炎急性发作期患者,先给予局部换药引流或扩创后VSD处理,全身抗感染或预防感染治疗,待急性感染期过后再彻底扩创、应用小腿组织瓣联合载抗生素硫酸钙人工骨填塞空腔、覆盖创面,予以修复重建；对11例慢性低毒性骨髓炎患者,给予彻底扩创后应用小腿组织瓣联合载抗生素硫酸钙人工骨一期填塞空腔、覆盖创面,予以修复重建。对7例扩创后骨缺损较多或空腔较大者,给予硫酸钙人工骨和自体髂骨混合植骨,采用肌瓣或肌皮瓣嵌合修复。组织瓣切取大小为2.0 cm×3.5 cm~12.0 cm×23.0 cm。通过门诊随访观察其临床疗效,参照McKee等骨感染治疗标准对疗效进行评价。结果:除1例组织瓣远端坏死经换药愈合外,其余组织瓣均顺利成活。随访12~40个月,平均18个月。1例骨髓炎术后1年复发,给予再次彻底扩创后,应用载抗生素硫酸钙人工骨联合自体髂骨混合植骨后痊愈。其余骨髓炎均顺利治愈,组织瓣外形、质地均良好,半年后不同程度地恢复保护性感觉,1年后肢体恢复负重及行走功能。按照McKee等骨感染治疗标准对疗效进行评价：治愈11例,好转4例,复发1例，总有效率93.8%。结论:应用小腿组织瓣联合载抗生素硫酸钙人工骨治疗胫骨骨髓炎,治愈率高,疗效显著,可明显减少手术次数,缩短病程。

abstractsObjective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.