儿童足跟部严重损伤的骨及软组织修复  

Repair of soft tissue and bone in children with badly damaged heel

作　　者：胡长青[1] 王顺义[1] 马战备[1] 张志桐[1] 李辉[1] 史占雷[1] 孙建涛[1] 马伟松[1] 于涛[1] 杨帅[1] 百思产 韩葛峰[1] 

机构地区：[1]保定市第一中心医院骨一科,071000

出　　处：《中华小儿外科杂志》2013年第5期366-368,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童足跟部严重损伤的骨及软组织修复方法。方法对9例（11侧患肢）儿童新鲜的足跟部严重损伤患儿急诊实施跟骨皮质包埋跟腱法修复跟骨及跟腱，腓动脉穿支蒂皮瓣逆行转移修复软组织缺损，伴有足底皮肤缺损的患儿同时行腓肠外侧皮神经移位后用于感觉恢复，术后随访1年。结果临床9例（11侧患肢）手术均顺利完成，所有跟骨及跟腱均愈合良好，皮瓣均成活，随访1年，皮瓣血运良好，质地柔软。踝关节屈伸平均达48°，接近健侧。修复足底的皮瓣共4例，感觉恢复达S3＋，两点分辨率为7～10rnnl。结论儿童足跟部严重损伤采用跟骨皮质包埋跟腱法修复跟骨及跟腱，腓动脉穿支蒂皮瓣逆行转移修复软组织缺损，其手术方式安全、可靠，腓肠外侧皮神经用于修复足底感觉时效果良好。Objective To discuss a new surgical procedure for repairing of soft tissue and bone defect in badly damaged heels of children. Methods Nine cases （11 limbs） of badly damaged heels were performed as emergency operations. The Achilles＇s tendon was embedded in the cortical bone of calcaneus and the pedicled flap with perforating branch of the peroneal artery was used for repairing the soft tissue defect of the heel. Lateral sural nerve was transferred for the recovery of the thenar sensation. All cases were followed up for one year. Results All operations were performed with no complications. Calcaneus and Achilles＇s tendon had reunited well. At 12 months postoperatively, the flap had good blood supply and soft texture. Ankle function was similar to the normal side, with an average arc of motion of 48°. The sensitivity of the flaps with nerve transferring （4 cases of plantar de- fect） reaches S＋ , 2-PD was 7 mm to 10 ram. Conclusions The technique of Achilles＇s tendon embed- ded in cortical bone of calcaneus, with calf flap is safe, and reliable for repairing badly damaged heels in children.

关 键 词：外科皮瓣 移植 软组织损伤 跟骨 

分 类 号：R726[医药卫生—儿科]