内踝复合组织缺损的修复重建  

Reconstruction of bone and skin defect at medial malleolns

作　　者：韩清銮[1] 栗威[1] 范洪进[1] 张清林[1] 张志[1] 

机构地区：[1]济宁医学院附属医院手足外科,山东省济宁市272029

出　　处：《中华显微外科杂志》2015年第4期354-358,共5页Chinese Journal of Microsurgery

基　　金：山东省自然科学基金（ZR2009CL010）;济宁市科技发展计划项目（2014jnwk08）

摘　　要：目的 探讨内踝复合组织缺损的修复重建方法. 方法 2013年1月至2015年1月,共收治内踝复合组织缺损患者11例,按损伤程度对病例进行分型（分四型）,根据类型,选用皮瓣、血管、神经、肌腱移植、皮瓣串联髂骨瓣移植修复,或直接踝关节融合、截肢等治疗;髂骨瓣供区给予保留部分髂前上棘并重建肌肉起止点,皮瓣供区给予植皮闭合创面. 结果 术后随访l-24个月,除截肢和踝关节融合各1例外,其余9例患者行踝关节修复重建保留踝关节,有1例感染,其他患者均愈合良好,不同程度恢复了踝关节功能,AOFAS踝-后足评分系统：优4例,良4例,差1例. 结论 内踝复合组织缺损四分类方法可以用来指导治疗方案的选择,皮瓣串联髂骨瓣等为主的复合组织移植是内踝缺损修复重建的可行方法.Objective To investigate the operative method and clinical rusults of repairing and reconstruction for bone and skin defect at medial malleolus.Methods Form January,2013 to January,2015,11 cases of patients with malleolus complex tissue defect were treated.According to the degree of damage to the cases were divided into four types,according to the type,selected flap,blood vessels,nerves,tendon graft,flap series connection iliac bone flap graft to repair,or direct ankle fusion,amputation to therapy.The Iliac flap donor site remained part of the anterior superior iliac spine and rebuild muscle starting and ending point,the donor sites wound was closed by skin graft.Results Followed-up of 1-24 months,in addition to amputation and ankle fusion each one exception,the remaining 9 patients underwent ankle reconstruction to reserve ankle.One case acquired infection,other 8 patients healed well,had different degree of recovery of the ankle function,the ankle function had recovery in different degree.AOFAS ankle-hindfoot score system：excellent in 4 cases,good in 4 cases,and poor in 1 case.Conclusion Ankle complex tissue defect classification method can be used to guide us to select the treatment options.Iliac bone flap series consisting mainly of composite tissue transplantation is a viable method of the medial malleolus defect reconstruction.

关 键 词：内踝 骨缺损 外科皮瓣 髂骨瓣 重建 

分 类 号：R658.3[医药卫生—外科学]