带肌骨膜的腓骨骨桥在小腿截肢术中的应用  

APPLICATIONS OF MYO-PERIOSTEAL FIBULAR BONE BRIDGING FOR TRAUMATIC TRANSTIBIAL AMPUTATION

作　　者：宋登新[1] 张前法[1] 朱诚[1] 何小文[1] 廖晓辉[1] 易成腊[2] 

机构地区：[1]上海市第一人民医院宝山分院骨科,上海200940 [2]华中科技大学同济医学院附属同济医院骨科

出　　处：《中国修复重建外科杂志》2013年第11期1300-1304,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市宝山区科技发展基金资助项目(11-E-24)~~

摘　　要：目的探讨带腓骨长短肌肌骨膜的腓骨骨桥成形术与传统截肢术行小腿创伤性截肢的临床疗效。方法2001年11月-2011年11月,应用带腓骨长短肌肌骨膜的腓骨骨桥成形术行小腿创伤性截肢17例（A组）,与采用传统小腿截肢术的21例患者（B组）比较临床疗效。两组患者性别、年龄、致伤原因、截肢原因、侧别、病程等比较,差异均无统计学意义（P〉0.05）,具有可比性。术后采用简明健康调查量表（SF-36）评定患者生活质量,并参考Trinity截肢和假肢体验量表（TAPES）调查患者假肢满意程度。结果术后两组患者切口均Ⅰ期愈合,无皮肤坏死、深部感染及不良残肢形成。两组患者均获随访,A组随访时间14～30个月,平均22个月;B组15～30个月,平均26个月。A组患者骨桥愈合良好,无骨不连,愈合时间（5.1±1.1）个月,B组患者愈合时间（3.3±0.6）个月,比较差异有统计学意义（t=9.82,P=0.00）。B组1例11岁患儿术后2年出现腓骨端骨刺,刺激皮肤影响假体使用;其他患者假肢均使用良好。术后12个月SF-36量表评定结果显示,A组在生理功能、社会功能、生理职能、活力、身体疼痛、总体健康6个维度的评分和总分均高于B组,差异有统计学意义（P〈0.05）;两组在情感职能和精神健康两个维度的评分差异无统计学意义（P〉0.05）。A、B组TAPES假肢满意程度评分分别为（12.12±2.23）分和（10.10±2.00）分,比较差异有统计学意义（t=2.891,P=0.006）。结论带腓骨长短肌肌骨膜的腓骨骨桥成形术行小腿创伤性截肢可取得良好临床疗效,患者术后生活质量、假肢满意度较高,是一种较好的小腿创伤性截肢治疗方法。Objective To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Methods Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 （group A） underwent myo-periosteal fibular bone bridging （the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation）, and other 21 （group B） underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups （P 〉 0.05）. The quality of life （QOL） was analyzed using 36-item short form health survey （SF-36）, and prosthesis satisfaction by Trinity amputation and prosthesis experience scale （TAPES）. Results Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months （range, 14- 30 months） in group A, and 26 months （range, 15-30 months） in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was （5.1 ± 1.1） months in group A and （3.3 ± 0.6） months in group B, showing significant difference between 2 groups （t=9.82, P=0.00）. Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 _＋ 14.01 in group A and 49.93 _＋ 12.78 in group B, showing significant difference （P 〈 0. 05）; the physical functioning, social functioning, role-physical, vitality, body pain, general health scores in group A were significantly higher than tho

关 键 词：创伤性截肢 腓骨骨桥 肌骨膜 假肢满意度 

分 类 号：R658.3[医药卫生—外科学]