Ilizarov技术结合腓肠神经或隐神经营养血管皮瓣治疗足踝部软组织缺损伴创伤后马蹄足畸形  

Ilizarov method combined with reversed sural or saphenous neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot

作　　者：王爽 舒衡生[2] 石博文[2] 沈义东 Wang Shuang;Shu Hengsheng;Shi Bowen;Shen Yidong(Postgraduate Institute,Tianjin Medical University,Tianjin 300070,China;Department of Orthopaedic Traumatology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医科大学研究生院,300070 [2]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2019年第5期305-312,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用Ilizarov技术结合腓肠神经或隐神经营养血管逆行岛状皮瓣转移治疗足踝部软组织缺损伴创伤后马蹄足畸形的疗效。方法回顾性分析2006年6月至2018年1月采用Ilizarov技术结合腓肠神经或隐神经营养血管逆行岛状皮瓣转移治疗21例足踝部软组织缺损伴创伤后马蹄足畸形患者资料,男17例,女4例;年龄26~65岁,平均43.9岁;软组织缺损面积6 cm×5 cm^10 cm×9 cm;软组织缺损距手术时间2.5~240.0个月;马蹄足畸形平均-38.9°(范围,-25°^-66°),平均活动度7.1°(范围,0°~18°)。21例患者均行Ilizarov外固定结合腓肠神经或隐神经营养血管逆行岛状皮瓣转移术,术后2周开始调整外固定架,逐渐缓慢矫正马蹄足畸形。术后随访皮瓣成活情况,并根据国际马蹄足畸形研究学组(International Club Foot Study Group, ICFSG)评分标准评价马蹄足畸形矫正情况。结果 21例患者中,应用腓肠神经皮瓣15例,隐神经皮瓣6例;皮瓣大小7 cm×6 cm^11 cm×10 cm。其中17例一期行皮瓣转移,4例于初次皮瓣切取回植术后2周行皮瓣延迟转移(3例采用逆行腓肠神经营养血管皮瓣,1例采用逆行隐神经营养血管皮瓣)。21例患者术后获得8~96个月,平均20.3个月随访,其中19例皮瓣术后完全成活,2例腓肠神经皮瓣远端边缘浅层坏死,经切痂、清创、换药后顺利愈合。4例患者外固定期间出现针道浅表感染,经换药及口服抗生素后治愈。所有患者马蹄足畸形均得到矫正,末次随访时踝关节活动度明显增加,平均22°(范围,8°~38°),ICFSG评分(5.67±3.09)分,较术前(30.81±3.63)分明显减小,两者比较差异有统计学意义(t=32.815,P=0.035);其中优13例、良7例、可1例,优良率95.24%(20/21)。末次随访时,无一例感染复发,患足畸形矫正,均能正常足跟着地行走。结论应用Ilizarov外固定结合腓肠神经或隐神经营养血管逆行岛状皮瓣转移治疗足踝部软组织缺损伴创伤后马蹄足�Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot. Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed. There were 17 males and 4 females, aged from 26 to 65 years, with an average age of 43.9 years. The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm, and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months. The mean preoperative equinus contracture was -38.9°(range,-25° to -66°), and total ankle range of motion (ROM) was 7.1°(range, 0°-18°). All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot. The flap survival was observed in the postoperative period, and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up. The criteria were used to assess the morphological and functional outcome. Results A total of 21 resversed flaps were transferred, including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps. The sizes of flaps were from 7 cm×6 cm to 11 cm×10 cm. Among them, 17 patients underwent primary flap transfer, and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery. The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap. All 21 patients were followed up and the average periodof follow-up was 20.3 months (range, 8-96 months). Among the 21 flaps, 19 survived completely. Although marginal necrosis was observed in 2 cases, these wounds healed after sub

关 键 词：外固定器 外科皮瓣 马蹄足畸形 

分 类 号：R658.3[医药卫生—外科学]