嵌合游离股骨内侧髁骨筋膜瓣修复手或足部长段骨及软组织复合组织缺损  

Reconstruction of composite bone and soft tissue defect of the hand or foot with the chimeric medial femoral condyle osteofascial free flap

作　　者：刘育杰 于龙华 任胜全 刘明明 王正丹 焦鸿生 陈浩 李秀忠 丁小珩 LIU Yujie;YU Longhua;REN Shengquan;LIU Mingming;WANG Zhengdan;JIAO Hongsheng;CHEN Hao;LI Xiuzhong;DING Xiaoheng(The Hand Surgery Center of PLA,The 971th Hospital of the CPLA,Qingdao,Shandong Province 266071,China;The Image Center of CPLA,The 971th Hospital of the CPLA,Qingdao,Shandong Province 266071,China)

机构地区：[1]中国人民解放军海军第971医院全军手外科中心,山东青岛266071 [2]中国人民解放军海军第971医院医学影像中心,山东青岛266071

出　　处：《中华显微外科杂志》2021年第5期521-525,共5页Chinese Journal of Microsurgery

基　　金：山东省医药卫生科技发展计划面上项目(202009010553)。

摘　　要：目的探讨应用嵌合游离股骨内侧髁骨筋膜瓣(CMFCOF)治疗手足部外伤性掌、指骨(跖骨)长段骨、软组织复合缺损的临床疗效。方法2015年1月至2020年3月,采用CMFCOF治疗外伤性手足部掌指骨(跖骨)缺损8例,男6例,女2例,年龄24~56(平均41)岁。致伤原因:车祸伤3例,机器挤压伤3例,压砸伤2例,均存在骨、软组织复合缺损。手近节指骨骨缺损2例,掌骨骨缺损3例,跖骨骨缺损3例;受伤到本次手术时间为2~120 d,平均84 d。骨缺损范围2.0 cm×1.2 cm×1.2 cm~4.4 cm×3.0 cm×2.3 cm,软组织缺损范围2.0 cm×1.4 cm~5.6 cm×4.5 cm。所有骨缺损位置均在骨干,不涉及关节。2例合并肌腱缺损。术中根据骨、软组织缺损面积切取相应大小CMFCOF,同时在筋膜瓣表面进行植皮。结果组织瓣切取时间为52~96 min,平均53 min。供区伤口直接闭合。术后所有患者受区植皮均顺利成活,受区和供区创面一期愈合。所有病例均获得随访。随访9~16个月,平均14.5个月。骨愈合时间为6~10周,平均7.5周。终末随访时所有病例均未行皮瓣修薄;供区功能恢复正常,无髌前区感觉障碍。5例手部损伤病例按中华医学会手外科学会断指再植功能评定试用标准进行评定:3例优,1例良,1例可;3例足部损伤病例根据Maryland足功能评分,结果均为优。结论CMFCOF具有术式简便、供区隐蔽、骨量优质、外形美观的优点,是修复手或足部长段骨、软组织复合缺损创面的一种较理想的方法。Objective To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap(CMFCOF)in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods Between January,2015 and March,2020,8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF.Of the 8 patients,there were 6 males and 2 females,with an average age of 41(range,24 to 56)years.The causes of injury included 3 of traffic accident,3 of machine crush and 2 of crush.Two cases had proximal phalanx defect,3 with metacarpal bone and 3 with metatarsal bone.The time between injury to the flap repair were 2 to 120(mean,84)days.The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm×3.0 cm×2.3 cm.The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm.All bone defects were on the diaphysis,without involvement of joints.Two cases had tendon defect.According to the defect of bone and soft tissue,the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results The average time of flap harvesting was 53(52-96)minutes.All donor sites were directly closed.All flaps and skin grafts achieved stage I survival.All patients entered 9-16 months of follow-up,with an average of 14.5 months.The average healing time of bone was 7.5(range,6-10)weeks.At the last follow-up review,all flaps were not thinned.The function of donor site was restored well,without weight bearing disorder and paraesthesia in the anterior patella area.According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association,3 patients were rated as excellent,1 was good and 1 was fair.According to the Maryland foot evaluation criteria,3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot.The flap has the advantages in simple operation,high quality of bon

关 键 词：股骨内侧髁骨瓣 嵌合骨皮瓣 掌骨 指骨 跖骨 骨缺损 

分 类 号：R658.3[医药卫生—外科学] R658.2[医药卫生—临床医学]