ï»?!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> 急性骨髓炎切开引æµæœ?/title> <meta name="keywords" content="手术,急性骨髓炎切开引æµæœ?创伤åŠéª¨ç§‘手æœ? /> <meta name="description" content="" /> <link href="http://images.whrenai.com/news_images/new_css.css" rel="stylesheet" type="text/css"> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script type="text/javascript" language="javascript" src="http://images.whrenai.com/js/copy.js "></script> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script language="javascript" src="http://images.whrenai.com/zx.js"></script> <script language='javascript' src='/js/Page.js'></script> <script language='javascript' src='/js/Xmlhttp.js'></script> <script language='javascript' src='/common/InfoViewCount.aspx?ModelId=1&&Id=70580'></script> </head> <body> <!--LOGO--> <div class=z1> <div class=logo><img 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end--> <div class=time>08-03-07 17:05:05　　　www.39.net　　　39</div> <!--time end--> <div class=key>关键è¯ï¼š<a href='/List.aspx?chid=18&Keyword=%e6%89%8b%e6%9c%af&FieldName=tagnamestr' target='_blank'>手术</a></div> <!--key end--> <div class=daodu></div> <!--ad end--> <div class=geyan><label><span>å¥åº·è°šè¯­</span></label></div> <!--geyan end--> <div class=concent fang=08-03-07 17:05:05> <br> <p>急性骨髓炎切开引æµæœ?/p><p>急性血æºæ€§åŒ–脓性骨髓炎（简称急性骨髓炎）多åŠå‘生在儿童，好å‘于长管骨的干骺端，最常è§äºŽè‚¡éª¨ã€èƒ«éª¨ã€‚早期诊断，早期治疗是æ高治愈率ã€é¢„防残废的关键。早期治疗包括åŠæ—©ã€è¶³é‡ã€æœ‰æ•ˆçš„全身抗生素治疗和支æŒç–—法，和åŠæ—¶çš„局部切开å‡åŽ‹ã€å¼•æµï¼ˆåŒ…括骨髓腔钻孔或开窗），以达到解除骨内脓肿的压力，é¿å…å‘髓腔扩散，防止åŠå‡å°‘骨质的破å与å死的目的。术åŽåº”继续应用抗生素直至炎症消失ã€?/p> <img border="0" src="../../Files/Shoushu/200812714413293777801.jpg" > ⑴切å? <img border="0" src="../../Files/Shoushu/200812714413298477802.jpg" > ⑵钻孔引æµ? <img border="0" src="../../Files/Shoushu/20081271441331577803.jpg" > ⑶“开窗â€æ‰©å¤§å¼•æµ? å›?　左侧胫骨急性骨髓炎切开引æµæœ? <p>[适应è¯]</p><p>1.急性骨髓炎一ç»æ˜Žç¡®è¯Šæ–­ï¼Œç”¨æŠ—生素等全身治疗ä¸è§æ˜¾è‘—效果者，应åŠæ—¶åˆ‡å¼€ä½œç—…å˜åŒºéª¨å†…或髓腔钻孔探查，如有脓液应开窗引æµã€?/p><p>2.局部穿刺è¯å®žæœ‰éª¨è†œä¸‹è„“肿者或x线片示骨膜下阴影增厚者，除切开引æµå¤–，应作髓腔引æµã€?/p><p>3.骨膜下脓肿穿破至软组织并形æˆè„“肿，应åŒæ—¶å¼•æµè½¯ç»„织脓肿和髓腔内脓肿ã€?/p><p>[术å‰å‡†å¤‡]</p><p>急性骨髓炎都伴有较严é‡çš„全身败血症或脓毒血症症状，病儿多数病情较é‡ã€‚为使病儿能è€å—手术，术å‰åº”采å–以下措施，改善全身情况：</p><p>1.全身应用足é‡ã€æ•æ„Ÿçš„抗生素控制感染ã€?/p><p>2.全身情况衰弱ã€è´«è¡€ã€ç—…情é‡å±æˆ–有中毒性休克者，应积æžè¾“è¡€ã€è¾“液，纠正脱水ã€é…¸ä¸­æ¯’等，待病情好转åŽæ‰‹æœ¯ã€?/p><p>3.将病肢作牵引或外固定制动，抬高患肢ã€?/p><p>[麻醉]</p><p>æ ¹æ®ç—…å˜éƒ¨ä½ã€å¹´é¾„，采用臂丛麻醉ã€è…°éº»ã€ç¡¬è†œå¤–麻醉或全麻ã€?/p><p>[手术步骤]</p><p>以胫骨上端骨髓炎为例ï¼?/p><p>1.体ä½ã€åˆ‡å£ã€€ä»°å§ä½ã€‚å‰å†…侧切å£æˆ–在体å¾æœ€æ˜Žæ˜¾çš„部ä½ä½œåˆ‡å£[å›? â‘´]，长3ï½?cm。切å£ä¸­ç‚¹åº”ä½äºŽä¸´åºŠåŽ‹ç—›ã€è‚¿èƒ€æœ€æ˜Žæ˜¾å¤„ã€?/p> <p>2.显露ã€é’»å­”探查　切开皮肤，常å¯å‘现骨膜水肿ã€è‚¥åŽšæˆ–被骨膜下脓肿所抬起。如有骨膜下脓肿，ç»ç©¿åˆºè¯å®žå³çºµè¡Œåˆ‡å¼€éª¨è†œå¼•æµå‡ºè„“液并é€åŸ¹å…»ï¼Œè‹¥æ— è„“液，也常å¯è§ç—…å˜åŒºçš®è´¨éª¨è½»åº¦ç²—糙，色泽ç°ç™½ã€‚å¯å°†éª¨è†œå‘两侧ç¨ä½œå‰¥ç¦»ï¼ˆå‰¥ç¦»å°½é‡å‡å°‘，以ä¿è¯éª¨çš„供血），用骨钻钻孔数个，直达骨髓腔，以探查有无骨髓腔脓肿。如髓腔无脓液溢出，钻孔已达å‡åŽ‹ä½œç”¨ï¼Œå³ç»“æŸæ‰‹æœ¯ï¼Œå±€éƒ¨ç½®æŠ—èŒè¯ç‰©åŽç¼åˆåˆ‡å£[å›? ⑵]ã€?/p> <p>3.开窗扩大引æµã€€é’»å­”åŽå¦‚å‘现有脓液自髓腔内æµå‡ºï¼Œåº”å³ç”¨éª¨å‡¿åœ¨é’»å­”部ä½å‡¿é™¤1cm宽ã€é€‚当长度的皮质骨，开窗以通畅引æµã€‚用生ç†ç›æ°´å†²æ´—，除去å死组织和游离的碎骨片，但ä¸è¦ä½œé«“腔内æ”刮[å›? ⑶]，以å…扩散感染ã€?/p> <p>4.引æµã€ç¼åˆã€€å¸å‡€è„“液，冲洗伤å£ï¼Œç½®å…¥é’ã€é“¾éœ‰ç´ ç²‰å‰‚或其他æ•æ„ŸæŠ—生素åŽï¼Œæ¾æ¾ç¼åˆåˆ‡å£ï¼Œåˆ‡å£æ·±éƒ¨æ”¾ä¸€å¡‘料管以利术åŽå¼•æµã€å†²æ´—和注è¯æ²»ç–—。脓多腔大者å¯ç½®åŒç®¡é—­åˆçŒæ´—负压引æµã€‚对骨破å严é‡ã€è„“液粘稠者宜在骨开窗å£æ”¾ç½®å¼•æµæ¡å¼€æ”¾å¼•æµã€?/p><p>[术中注æ„事项]</p><p>1.剥离骨膜范围必须尽é‡ç¼©å°ï¼Œä»¥å‡å°‘å‘生骨局部缺血性å死的机会ã€?/p><p>2.开窗时，凿除皮质骨ä¸å®œè¿‡å¤šï¼Œå°½é‡å‡å°‘局部扰乱与æŸä¼¤ï¼Œä»¥èƒ½è¾¾åˆ°é«“腔内å‡åŽ‹ã€å¼•æµçš„目的å³å¯ã€?/p><p>3.一般ç¼åˆä¼¤å£æœ‰åˆ©äºŽé˜²æ­¢ç»§å‘感染，但应å–决于全身与局部感染的程度。对脓液多ã€å±€éƒ¨ç‚Žç—‡é‡ã€å…¨èº«ä¸­æ¯’症状é‡æ‹‰ç禽尖行开放引æµã€?/p><p>[术åŽå¤„ç†]</p><p>1.继续全身应用抗生素，至体温正常åŽ2ï½?周。ç¼çº¿äºŽæœ¯åŽ10ï½?4日拆除ã€?/p><p>2.制动或牵引并抬高病肢到急性症状消退为止。骨破å严é‡ã€èŒƒå›´å¤§è€…应用包括病骨二端关节ã€åˆ¶åŠ¨æœ‰æ•ˆçš„石è†å¤–固定，防止病ç†æ€§éª¨æŠ˜å‘生。一般在1ï½?æ—¥åŽæ‘„片å¤æŸ¥ï¼Œæ ¹æ®è§‚察的病骨演å˜æƒ…况，决定下一步治疗ã€?/p><p>3.置引æµç®¡çš„è¦ä¿æŒå¼•æµé€šç•…，当脓腔å˜å°ã€å¼•æµç‰©å¾ˆå°‘æ—¶æ‰é€æ¸æ‹”除。åŒç®¡é—­åˆçŒæ´—ã€è´ŸåŽ‹å¼•æµè§é—­åˆçŒæ´—ã€è´ŸåŽ‹å¼•æµæœ¯ã€‚开放引æµçš„伤å£ï¼Œç»æ¢è¯åŽåˆ†æ³Œç‰©ä¸å¤šã€åˆ›é¢è‚‰èŠ½å¥åº·ï¼Œå¯ä½œå»¶æœŸç¼åˆã€‚一期ç¼åˆçš„伤å£å¦‚有感染加é‡ï¼Œåº”åŠæ—¶å¼€æ”¾å¼•æµã€?/p> </div> 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