股前外侧皮瓣联合大隐静脉移植治疗肘部大面积软组织缺损伴肱动脉栓塞  

Anterolateral thigh flap combined with great saphenous vein transplantation in the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism

作　　者：王乾坤 申才良[1] 李俊杰[2] 李勇[2] 陈亮[2] 罗彬 Wang Qiankun;Shen Cailiang;Li Junjie;Li Yong;Chen Liang;Luo Bin(Department of Orthopedics,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Orthopedics,Fuyang Peopled Hospital Affiliated to Anhui Medical Universityy Fuyang 236000,China)

机构地区：[1]安徽医科大学第一附属医院骨科,合肥230022 [2]安徽医科大学附属阜阳市人民医院骨科,236000

出　　处：《中华创伤杂志》2021年第9期799-804,共6页Chinese Journal of Trauma

基　　金：安徽省阜阳市人民医院2020年新技术项目(FY2020-025)。

摘　　要：目的探讨股前外侧皮瓣联合大隐静脉移植治疗肘部大面积软组织缺损伴肱动脉栓塞的临床疗效。方法采用回顾性病例系列研究分析2017年3月至2020年3月安徽医科大学附属阜阳市人民医院收治的19例肘部大面积软组织缺损伴肱动脉栓塞患者的临床资料,其中男15例,女4例;年龄14~59 岁[(37.6±14.1)岁]。肘部软组织缺损面积为7 cm×3 cm~12 cm×5 cm。术前均通过血管造影明确患侧上肢肘段肱动脉完全栓塞,栓塞长5~12 cm[(7.3±1.6)cm]。患者均采用股前外侧皮瓣联合大隐静脉移植术治疗。记录手术时间、术中出血量。术后1周复查患侧上肢血管造影观察肱动脉通血和皮瓣成活情况。比较术后3,6,12个月皮瓣肿胀程度、肘关节Broberg-Morrey功能评分和瘢痕挛缩情况。观察皮瓣供区愈合及并发症情况。结果患者均获随访12~24个月[(18.1±3.0)个月]。手术时间为3.5~6.4 h[(4.9±0.8)h]。术中出血量为200~600 ml[(338.7±101.6)ml]。术后1周,肱动脉血流均通畅,皮瓣全部成活。术后12个月,皮瓣肿胀程度为(0.9±0.3)cm,显著小于术后3,6个月的(1.2±0.3)cm和(1.1±0.3)cm(P<0.05)。术后12个月,肘关节Broberg-Morrey功能评分为(87.8±4.8)分,显著高于术后3,6个月的(71.4±7.0)分和(80.2±4.8)分(P<0.05)。术后12个月,肘关节功能评分优9例,良8例,中2例,优良率为90%。术后12个月,瘢痕挛缩发生率为63%(12/19),显著高于术后3个月的11%(2/19)(P<0.05),但与术后6个月的42%(8/19)比较,差异无统计学意义(P>0.05)。皮瓣供区均愈合,均未发生血管或皮瓣相关并发症。结论股前外侧皮瓣联合大隐静脉移植治疗肘部大面积软组织缺损伴肱动脉栓塞,患肢远端血运恢复顺利,皮瓣成活率高,术后肢体功能恢复佳,为临床严重肘部创伤的治疗提供了一种可行方案。但由于围术期肘关节制动等多方面因素,皮瓣受区容易出现瘢痕挛缩。Objective To investigate the clinical outcomes of anterolateral thigh flap romhined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020.There were 15 males and 4 females,aged 14-59 years[(37.6±14.1)years].The areas of elbow soft tissue defects ranged from 7 cmx3 cm to 12 cmX5 cm.Before operation,angiography test was performed to confirm brachial artery emlmlism of the affected upper limb.The length of embolization ranged from 5 to 12 cm[(7.3±1.6)cm].All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation.The operation time and intraoperative blood loss were recorded.Angiography test was re-examined one week after operation.The degree of flap swelling,elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3,6,and 12 months.Healing of donor site and postoperative complications were observed.Results All patients were followed up for 12-24 months[(18.1±3.0)months].The operation duration was 3.5-6.4 hours[(4.9±0.8)hours],with intraoperative blood loss of 200-600 ml[(338.7±101.6)ml].The blood flow of repaired brachial artery was unobstructed in all patients one week after operation,with all flaps survived.The degree of flap swelling was(0.9±0.3)cm at postoperative 12 months,significantly reduced from that at postoperative 3 and 6 months[(1.2±0.3)cm,(1.1±0.3)cm](P<0.05).The elbow Broberg-Morrey functional score was(87.8±4.8)points,significantly higher than those at postoperative 3 and 6 months[(71.4±7.0)points,(80.2±4.8)points](P<0.05).The rating of elbow function score was excellent in 9 patients,good in 8 and fair in 2 at postoperative 12 months,with the

关 键 词：前臂损伤 血栓栓塞 移植 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]