儿童足跟部开放性损伤伴踝关节脱位的治疗  

Treatment of children's heel open injuries with ankle joint dislocation

作　　者：王磊[1] 王平均[1] 乔少林[1] 范克轩[1] 陈翰林[1] 孟勐[1] 黄东[1] 陆欢[1] 

机构地区：[1]解放军第123医院骨科,安徽蚌埠233015

出　　处：《安徽医学》2015年第2期151-153,共3页Anhui Medical Journal

基　　金：蚌埠市医疗卫生类科技指导项目(项目编号:20140339)

摘　　要：目的探讨儿童足跟部开放性损伤伴踝关节脱位的治疗方法和效果。方法10例足跟部开放性损伤伴踝关节脱位患儿急诊清创，踝关节复位后克氏针固定，行负压封闭引流（VSD）覆盖创面；2周后手术重建跟腱、腓肠神经营养血管皮瓣或隐神经营养血管皮瓣逆行转移覆盖软组织缺损创面。结果10例患者皮瓣愈合良好，按期拆线。皮瓣修复术后6周拔除固定踝关节的克氏针开始功能锻炼。所有患儿均获随访，时间6～16个月。踝关节功能按Baird-Jackson评分标准进行功能评价：优7例，良2例，可1例，差0例，优良率90．0％。所有皮瓣血运良好，色泽接近正常。结论足跟部开放性损伤伴踝关节脱位患儿急诊清创关节复位，2周后手术重建跟腱及皮瓣转移修复缺损的软组织，可以取得满意的效果。Objective To explore the treatment choice and effect of children′s heel open injuries with ankle joint dislocation.Meth-ods 10 cases of children's heel open injuries with ankle joint dislocation were studied.First,each patient underwent exhaustive debridement to the open injuries,with Kirschner wire fixation after the ankle joint dislocation being restored,and then the wounds were covered with dress-ings and VSD (vacuum sealing drainage)was used continuously.Two weeks later,the injured achilles tendons were reconstructed,and ple-rosis of the soft tissue defects were operated by reversed transferring of sural neurovascular fasciocutaneous flap or saphenous nerve nutritional vessels flap.Results The wounds healed well in all cases and the stitches were taken out on schedule.Six weeks after the skin flap repai-ring operation,Kirschner wires were removed and the children started rehabilitation training of ankle joint function.After the follow-up period of 6~16 months,the function of ankle joint was evaluated by Baird-Jackson grading standard:excellent in 7 cases,good in 2 cases,normal in 1 case,bad in 0 cases,with 90.0% excellent rate.The blood supply of all skin flaps was sufficient and the skin color was approximate normal.Conclusion Exhaustive debridement and fixed ankle joint restoration,together with later achilles tendon reconstruction and skin flap repairing operation,is a effective and reasonable treatment choice to children's heel open injuries with ankle joint dislocation.

关 键 词：儿童 足跟损伤 脱位 踝关节 

分 类 号：R726.8[医药卫生—儿科]