开放性跟腱缺损一期重建的远期随访  

Open Achilles tendon defects： reconstructive surgeries and long term follow-up

作　　者：朱跃良[1] 徐永清[1] 王家祥 殷作明[3] 张西正[4] 吕乾[1] 浦绍全 吴一芃[1] 赵泽雨 

机构地区：[1]成都军区昆明总医院骨科,昆明650032 [2]罗平县人民医院骨科,曲靖655800 [3]西藏军区总医院,拉萨850000 [4]军事医学院科学院,北京100850

出　　处：《中华骨科杂志》2016年第9期534-539,共6页Chinese Journal of Orthopaedics

基　　金：成都军区医学科学技术研究计划项目（B14012）

摘　　要：目的研究开放性跟腱缺损一期重建的方法及重建后跟腱的远期功能。方法回顾性分析1999年1月至2011年12月治疗31例开放性跟腱缺损患者资料，男19例，女12例；年龄4-55岁，平均23．1岁；左侧7例，右侧24例；轮辐伤18例，碾压伤6例，机器伤6例，刀伤1例；跟腱缺损范围为1-11cm，平均7．1cm；软组织缺损面积为3cm-3cm-12cm-10cm；合并跟骨骨折10例，跟骨结节部缺损5例。开放性跟腱缺损均一期重建，根据跟腱和软组织缺损的严重程度选择术式，其中采用双蒂腓肠肌皮瓣下滑15例，跖屈下缝合10例，翻转跟腱瓣1例，半腱肌自体移植1例，阔筋膜张肌移植重建l例，异体肌腱移植3例；结合使用游离皮瓣（7例）和带蒂皮瓣（24例）重建跟周皮肤缺损。跟骨骨折患者行螺钉（6例）和克氏针（4例）固定。5例跟骨结节部缺损未行处理。结果31例患者均获得随访，随访时间1-6年，平均1．8年。术后2-4d，7例出现皮瓣局部坏死，行局部皮瓣转移后完全覆盖创面。无一例发生皮瓣完全坏死和跟腱再断裂。31例患肢全部恢复行走功能，其中19例（61．3％，19／31）患侧足可单独提踵，12例无法单侧提踵（38．7％，12／31）。与健侧相比，31例（100．0％，31／31）恢复踝最大跖屈范围；21例（67．7％，21／31）恢复踝最大背伸范围，10例（32．3％，10／31）踝最大背伸减少范围为5°-25°。结论跟腱缺损≤4cm时，可以使用局部皮瓣结合跟腱缝合完成；缺损在4-11cm时，可以使用腓肠肌下滑皮瓣，缺损〉11cm时，使用游离穿支皮瓣结合自体肌腱移植。重建后跟腱远期的力量和弹性恢复良好。Objective To explore the reconstructive surgeries for open Achilles tendon defects and their long term out- comes. Methods A retrospective review was performed on 31 patients with open Achilles tendon defects treated at our center. There were 19 males and 12 females with an average age of 23.1 years （range, 4-55 years）. There were 7 cases on left side and 24 on right. The injury causes included spoke injuries （18 cases）, crash injuries （6 cases）, machine injuries （6 cases）, and cut injuries （1 case）. The defect lengths of the Achilles tendons in the study ranged from 1 to llcm and the soft tissue defects ranged from 3 emX3 em to 12 emx i0 era. There were 10 cases with caleaneus fractures. Surgeries for Achilles tendon defects included sliding the Achilles tendon stump down with the sliding gastrocnemius musculoeutaneous flap （15 cases）, suture at the plantar flexion （10 cases）, tendon flap turndown （1 case）, hamstring tendon autograft （1 case）, fascia lata muscle reconstruction （1 case） and tendon al- lograft （3 cases）. Free flaps （7 cases） and non-free flaps （24 cases） were used for the coverage of concomitant skin defects. The eal- caneus fractures were fixed with screws （6 cases） or K-wires （4 cases）. The treatment protocols were based on the defect length of the Achilles tendon. Results The follow up period was 1-6 years （average, 1.8 years）. There was no total flap failure or tendon re -rupture, while 7 cases who had partial flap loss 2-4 days after the surgeries. In the latest follow-up, all the cases had regained full walking abilities： 19 cases （61.3%, 19/31） even had regained the heel raising by the reconstructed foot while 12 cases （38.7%） can- not. Compared with the contralateral side, 31 cases＇ （100.0%）reconstructed ankles had the maximum plantar flexion, while 21 cases （67.7%） had the maximum dorsal extention. Ten cases （32.2%） lost their maximum dorsal extension ranging from 5° to 25°. Conclusion There are many

关 键 词：跟腱 创伤和损伤 外科皮瓣 

分 类 号：R687.2[医药卫生—骨科学]