儿童复杂跟腱缺损的修复重建  

Repair of Complex Achilles Tendon Defect in Children

作　　者：王季[1,2] 蔡锦方[1] 王建超[1] 李宗玉[1] 曹学成[1] 张继党 

机构地区：[1]第二军医大学济南临床医学院济南军区总医院骨创科,山东济南250031 [2]解放军第401医院骨创科,山东青岛260071

出　　处：《实用骨科杂志》2016年第8期697-700,共4页Journal of Practical Orthopaedics

摘　　要：目的了解应用带腓肠肌腱膜的腓动脉穿支皮瓣修复儿童复杂跟腱缺损的效果。方法 2009年10月至2014年12月收治儿童复杂跟腱缺损12例,采用带腓肠肌腱膜的腓动脉穿支皮瓣进行修复。其中男7例,女5例;年龄3~13岁。车辆轮辐伤8例,砸伤2例,挤压伤1例,交通事故伤1例。5例为新鲜缺损,7例为陈旧性缺损。皮肤缺损范围22~64 cm^2,跟腱缺损长度3.5~7.0 cm。统计手术前后踝关节动度、AOFAS评分、SF36评分,对疗效进行评价。结果一期愈合8例,皮瓣表皮坏死2例,皮瓣远端坏死1例,感染复发1例。术后1年踝关节跖屈明显优于术前和术后3个月,差异有统计学意义（P〈0.01）;术后1年踝关节背伸优于术后3个月,差异有统计学意义（P〈0.01）,略低于术前,差异无统计学意义（P〉0.01）。术后1年AOFAS评分及SF36评分均较术前和术后3个月明显增加,差异有统计学意义（P〈0.01）。结论带腓肠肌腱膜的腓动脉穿支皮瓣是一种修复儿童复杂跟腱缺损的较理想方法。Objective To observe the clinical effect of peroneal artery perforator flap combined gastrocnemius aponeurosis on repairing complex Achilles tendon defect in Children. Methods Between October 2009 and December 2014,12 cases of complex Achilles tendon defects in children were repaired with peroneal artery perforator flap combined gastrocnemius aponeurosis. 5 cases were fresh injury,7 cases were old defects. The size of the wounds ranged from 22 cm^2 to 64 cm^2. The length of tendon defect ranged from 3. 5 cm to 7. 0 cm. The clinical outcome was evaluated by Ankle joint dynamic degree,AOFAS score and SF36 score before and after operation. Results 8 cases were primary healed. 2 cases with skin necrosis and 2 cases with donor site necrosis. 1 cases experience recurrent infection. The plantar extension at 1 year was significantly better than that at 3months after operation and pre-operation. The dorsal extension at 1 year was significantly better than that at 3 months after operation,but no significant difference was found between at 1 year and pre-operation. The AOFAS score and SF36 score at 1 year after operation were significantly larger than those at 3 months after operation and pre-operation. Conclusion Peroneal artery perforator flap with gastrocnemius aponeurosis is an ideal repair method in repairing complex achilles tendon defect in Children.

关 键 词：跟腱 组织缺损 腓肠肌腱瓣 修复 

分 类 号：R686.1[医药卫生—骨科学]