脑瘫足腓侧负重区域外伤致慢性骨髓炎伴创面的显微外科治疗体会  

Microsurgical treatment of chronic osteomyelitis with wound caused by cerebral palsy foot fibular weight bearing area trauma

作　　者：史洪成 王殿丰 孟凡琼 于跃 张振军 张国东 张德洪 常非[3] Shi Hongcheng;Wang Dianfeng;Meng Fanqiong;Yu Yue;Zhang Zhenjun;Zhang Guodong;Zhang Dehong;Chang Fei(Hand and Foot Microsurgery,Changchun Orthopedics Hospital,Changchun 130000,China;Hand and Foot Microsurgery,Yunnan Sino-German Orthopedic Hospital,Kunming 650000,China;Department of foot and ankle surgery,Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]长春骨伤医院手足显微外科,吉林长春130000 [2]云南中德骨科医院手足显微外科,云南昆明650000 [3]吉林大学第二医院足踝外科,吉林长春130041

出　　处：《足踝外科电子杂志》2021年第1期32-38,共7页Electronic Journal of Foot and Ankle Surgery

基　　金：吉林省财政厅(ZXWSTZXEY001);吉林省科技厅(20190304121YY);吉林省卫生厅(2016WST125);吉林省发展和改革委员会(2021C042-3)。

摘　　要：目的探讨脑瘫足腓侧负重区域外伤致慢性骨髓炎伴创面患者应用游离股前外侧皮瓣显微外科临床治疗体会。方法2012年7月—2019年12月,本科室收治脑瘫足腓侧负重区域外伤致慢性骨髓炎伴创面患者7例。病例均为脑性瘫痪分型为痉挛型脑瘫特殊类型患者,其中6例为轻中度马蹄内翻足,1例重度马蹄内翻足;入院见患足有一大小(1.5 cm×1.0 cm)±0.5 cm2创面,深达骨质,窦道有脓性渗出伴有臭味。行扩大切除并行负压封闭引流(vacuum sealing drainage,VSD)技术,1周后采用携带股前外侧皮神经及阔筋膜的游离股前外侧皮瓣显微技术修复,既能折叠阔筋膜填充无效腔及覆盖创面,又能吻合足部腓侧感觉神经,形成新的有感觉的负重区,同时大腿供区直接闭合。结果所有病例皮瓣术后无血管危象发生,全部顺利存活,皮瓣术后15 d恢复即下床负重行走。全部病例得到最短9个月、最长4年3个月随访,7例中1例因足部畸形加重未及时行矫正手术,皮瓣出现浅表磨损,经简单换药后愈合,余患者维持原足部畸形情况下无再发创面及破溃。2例因皮瓣术后外观稍显臃肿,稍做修形改善。术后足腓侧负重区饱满,无空腔,滑动良好,恢复负重功能;皮瓣色泽、质地、外形功能均良好;无创面、破溃及骨髓炎复发。术后2~4个月皮瓣逐渐恢复触、痛、温觉,皮瓣质地柔软,厚度适中,有弹性,有排汗功能,8个月后保护性感觉恢复良好;并且皮瓣供区直接闭合瘢痕较小,对下肢行走功能无影响。结论脑瘫足腓侧负重区域外伤致慢性骨髓炎伴创面是困扰外科的一个难题,实际工作中很多患者已适应畸形行走,拒绝接受畸形矫正后创面慢慢换药愈合的治疗方法;控制感染覆盖创面是修复的良好选择。所以,脑瘫足腓侧负重区域外伤致慢性骨髓炎伴创面应用游离股前外侧皮瓣显微修复是一种可供选择的有效方法。Objective To explore the clinical experience of microsurgical treatment of patients with cerebral palsy foot and chronic osteomyelitis with trauma caused by trauma in the weight-bearing region of the fibular side of the foot with a free anterolateral femoral flap.Methods From July 2012 to December 2019,this department treated 7 cases of chronic osteomyelitis associated with trauma in the weight-bearing region of the fibular side of the horseshoe foot deformity of spastic cerebral palsy(hereinafter referred to as cerebral palsy foot).The cases were all patients with cerebral palsy classified as special type of spastic cerebral palsy,of which 6 cases were mild to moderate horseshoe inversion foot,and 1 case was severe horseshoe inversion foot;the affected foot had a size of(1.5 cm×1.0 cm)±0.5 cm2 trauma,deep to the bone,with purulent exudation from the sinus tract and a foul smell.Extended rese on and VSD were performed.One week later,the free anterolateral femoral flap was repaired by microscopic technique carrying the anterolateral femoral nerve and broad fascia,which could not only fold the broad fascia to fill the dead space and cover the wound surface,but also anastomose the sensory nerve of the peroneal side of the foot to form a new weight-bearing area with sensation,and at the same time,close the supply area of the thigh directly.Results All cases survived the flap surgery without vascular crisis,and were able to get out of bed and walk with weight bearing 15 days after the flap surgery.All the cases were followed up for a minimum of 9 months and a maximum of 4 years and 3 months.1 of the 7 cases was due to the aggravation of foot deformity without timely corrective surgery,and the flap showed superficial wear,which healed after a simple dressing change,while the remaining patients maintained the original foot deformity without recurrence of trauma and ulceration.2 cases had a slightly bloated appearance after the flap surgery,which was slightly modified and improved.The weight-bearing area on the peronea

关 键 词：脑瘫 马蹄内翻足畸形 慢性骨髓炎 创面 显微外科技术 

分 类 号：R64[医药卫生—外科学]