带血管蒂腓骨头复合组织瓣修复儿童内踝缺损的初步研究  

A PRELIMINARY STUDY ON REPAIRING DEFECTS AT MEDIAL MALLEOLUS IN CHILDREN BY VASCULARIZED FIBULAR HEAD COMPOSITE FLAP

作　　者：付兴茂[1] 范韶光[1] 刘勇[1] 李树亮[1] 王蕾[1] 季晓峰[1] 

机构地区：[1]解放军第89医院小儿骨科,山东潍坊261021

出　　处：《中国修复重建外科杂志》2013年第11期1305-1308,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨以带血管蒂腓骨头复合组织瓣修复儿童内踝骨及皮肤软组织缺损的方法及近期疗效。方法2008年11月-2011年1月,收治8例内踝骨及皮肤软组织缺损患儿。男5例,女3例;年龄2~9岁,平均4.6岁。机器绞伤2例,车轮绞伤6例。内踝完全缺损,软组织缺损范围为3.5 cm×3.0 cm^7.0 cm×4.5 cm。受伤至入院时间2~8 h,平均4.5 h。以带血管蒂腓骨头复合组织瓣行骨及软组织修复重建,其中5例复合组织瓣携带腓骨头周围皮肤,3例创面过大(>5 cm×4 cm),采用内踝上皮瓣修复软组织缺损。供区2例直接缝合,6例植皮修复。结果术后带血管蒂腓骨头复合组织瓣及内踝上皮瓣均顺利成活,创面均Ⅰ期愈合。供区1例植皮出现局部坏死吸收;其余植皮均顺利成活,切口均Ⅰ期愈合。8例均获随访,随访时间10个月~3年,平均22个月。皮瓣颜色及弹性良好。患儿双下肢等长,其中6例无关节内、外翻畸形;2例术后1年出现进行性踝关节内翻。5例踝关节屈伸功能恢复正常,3例轻度受限;水平侧方及前后移动均与健侧无差别。术后10个月按美国矫形足踝协会(AOFAS)足踝功能评价标准评定,获优5例,良3例。X线片示踝穴间隙与健侧发育基本同步,6例内踝骨骺无早闭及骨桥形成,2例于术后1年出现骨桥。结论带血管蒂腓骨头复合组织瓣修复儿童内踝骨及皮肤软组织缺损近期疗效满意,重建的内踝可随患儿生长同步发育,但远期疗效有待进一步随访观察。Objective To investigate the operative method and effectiveness of repairing defects at medial malleolus in children with vascularized fibular head composite flap. Methods Between November 2008 and January 2011, 8 children with bone and soft tissue defects at the medial malleolus were treated. There were 5 boys and 3 girls, aged 2-9 years （mean, 4.6 years）. Injuries were caused by machine twisting in 2 cases and by wheel twisting in 6 cases. Soft tissue defect area ranged from 3.5 cm × 3.0 cm to 7.0 cm × 4.5 cm; defect was total in all medial malleolus. The disease duration from injury to admission was 2-8 hours （mean, 4.5 hours）. Defects were repaired with vascularized fibular head composite flap carrying the skin around the head of the fibula in 5 cases, and with vascularized fibular head composite flap and skin flap above the medial malleolus in 3 cases having too large defect （〉 5 cm× 4 cm）. The donor sites were repaired with direct suture in 2 cases and with skin graft in 6 cases. Results M1 8 fibular head composite flaps and 3 skin flaps above the medial malleolus survived completely. Wounds healed by first intention; the skin grafts at donor sites survived in the other cases except 1 case having local necrosis, with healing of incision by first intention. The patients were followed up 10 months to 3 years （mean, 22 months）. The color and elasticity of the flaps were good. M1 the children had equal leg length. Of 8 cases, 6 had no joint valgus; 2 cases had progressive ankle varus after 1 year of operation. The ankle flexion and extension function r.eturned to normal in 5 cases, and was slightly limited in 3 cases; horizontal side, forward and backward movements had no difference compared with normal side. According to American Orthopaedic Foot and Ankle Society （AOFAS） ankle function evaluation criteria, the results were excellent in 5 cases, and good in 3 cases at 10 months after operation. X-ray film showed that the ankle hole gap development of both sides was similar; no prematur

关 键 词：带血管蒂腓骨头复合组织瓣 骨骺损伤 内踝缺损 儿童 

分 类 号：R726.8[医药卫生—儿科]