内踝后双蒂皮瓣在跟腱闭合性损伤修复术中的应用  

Application of Double Pedicled Flap of Posterior Medial Malleolus in Repairing Closed Achilles Tendon Injury

作　　者：梅毅宁 杨秋贤 MEI Yi-ning;YANG Qiu-xian(Department of orthopedics,Taishan hospital of traditional Chinese medicine,jiangmen,guangdong province 529200)

机构地区：[1]台山市中医院骨三科,广东台山529200 [2]台山市中医院,广东台山529200

出　　处：《中国伤残医学》2020年第15期1-2,共2页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨内踝上双蒂皮瓣治疗跟腱修复术中皮肤缺损的临床效果。方法:选取本院2017年1月-2019年1月收治的跟腱闭合性断裂患者10例,所有患者均行跟腱断裂切口吻合修复术,且术中出现皮肤缺损,均1期闭合创面。分成2组,第1组5例,张力下直接缝合闭合创面,另一组5例,行内踝上双蒂皮瓣修复闭合创面。术后对住院天数,切口愈合情况进行比较,术前后根据AOFAS评分,出院后根据Arner-Lindholm评分标准进行随访,评价术后恢复情况。结果:第1组4例患者均出现术后皮肤坏死并跟腱外露,需进一步皮瓣手术修复,第2组有4例患者伤口Ⅰ期愈合,仅有1例患者出现皮瓣局部坏死,经清创缝合术后愈合。所有患者均获随访,时间8个月,所有患肢功能恢复满意。结论:对闭合性跟腱断裂,基层医院由于缺乏器械及病人资金原因,多无法行微创手术治疗,多采用传统开放性吻合修复术治疗,但术中易出现切口无法松弛缝合,引起隐性皮肤缺损,本研究对此进行内踝后双蒂皮瓣手术治疗,取得满意效果。Objective:To investigate the clinical effect of the double-pedicled flap on inner malleolus in the treatment of Achilles tendon repair.Methods:10 cases of patients with closed rupture of Achilles tendon admitted to our hospital from January 2017 to January 2019 were selected.All patients underwent incision anastomosis and repair of Achilles tendon rupture,and skin defects occurred during the operation,and all the wounds were closed in one stage.Divided into two groups,the first group of 5 cases,direct suture under tension to close the wound surface,the other group of 5 cases,the inner malleolus upper double pedicle flap repair closed wound surface.Postoperative length of stay and wound healing were compared.Preoperative and postoperative AOFAS scores were followed up according to arner-lindholm scoring standards after discharge to evaluate postoperative recovery.Results:Four patients in the first group,postoperative skin necrosis and tendon exposed,further flap repair surgery,the second group ofⅠwound healing in 4 patients,only 1 case patients with local necrosis,skin flap debridement suture heals.All patients were followed up for 8 months,and the function of all affected limbs recovered satisfactorily.Conclusion:With closed Achilles tendon rupture,basic-level hospitals due to lack of equipment and patient capital,more can't do minimally invasive surgery treatment,treatment with more traditional open anastomosis repair,but can't slack suture of incision which were liable to occur during operation,cause the recessive skin defect,this study on medial malleolus after double pedicle.

关 键 词：跟腱断裂 皮肤缺损 皮瓣 皮肤坏死 

分 类 号：R622[医药卫生—整形外科]