腓动脉穿支蒂螺旋桨皮瓣修复结合综合干预对足踝软组织缺损患者修复效果的影响  

Effect of the peroneal artery perforator pedicle propeller flap repair combined with a comprehensive intervention in patients with soft tissue defects of foot and ankle

作　　者：杨嘉洲 姚强[1] 曲鑫[1] YANG Jiazhou;YAO Qiang;QU Xin(Department of Hand,Foot and Ankle Microsurgery,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院手足踝显微外科,沈阳110004

出　　处：《长春中医药大学学报》2022年第3期318-322,共5页Journal of Changchun University of Chinese Medicine

基　　金：国家卫生健康委“十四五”规划全国重点课题(YYWS3089)。

摘　　要：目的分析腓动脉穿支蒂螺旋桨皮瓣修复结合综合干预对足踝软组织缺损患者修复效果的影响。方法选择足踝软组织缺损患者50例作为研究对象,患者均采用腓动脉穿支蒂螺旋桨皮瓣修复进行治疗,住院期间患者均进行综合干预,均随访3个月。比较腓动脉穿支蒂螺旋桨皮瓣修复结合综合干预的临床应用效果,术后1、2、3 d皮温情况,随访3个月后记录患者美国矫形外科足踝协会(AOFAS)评分和Maryland足部评分。结果 50例患者移植皮瓣均成活,随访3个月后,所有患者术区无水肿、破溃,移植皮瓣质地、色泽等与周围皮肤接近,蒂部平整,外表美观,AOFAS评分:足部对线(7.36±2.43)分,内翻加外翻(5.29±0.63)分,屈曲加伸展(7.43±0.42)分,踝-后足稳定性(6.83±0.57)分,最大步行距离(4.25±0.47)分,疼痛(32.74±4.57)分,地面步行(4.36±0.53)分,自主活动、支撑情况(8.32±1.35)分,反常步态(6.61±1.36)分,总分(83.19±5.83)分。随访3个月后,50例患者Maryland足部评分得分为(87.27±4.37)分,其中得分优31例,得分良19例;所有患者足部深感觉均恢复,中心感觉恢复为S^(3),边缘浅感觉恢复较佳,边缘部位感觉恢复多为S^(4),其他术区浅感觉呈区域性恢复,两点辨别觉为(20.16±2.31)mm。术后1 d,50例患者皮温间隔4 h高于间隔1、2 h,间隔8 h高于间隔1、2、4 h(P<0.05);术后2 d,50例患者皮温间隔4 h高于间隔1、2 h,间隔8 h高于间隔1 h(P<0.05);术后3 d,50例患者皮温间隔8 h高于间隔2、4 h(P<0.05)。结论腓动脉穿支蒂螺旋桨皮瓣修复结合综合干预可有效修复足踝软组织缺损患者创面,控制患者术后皮温,促进患者足部行走和感觉功能恢复,具有良好的治疗效果。Objective To analyze the effect of the peroneal artery perforator pedicle propeller flap repair combined with a comprehensive intervention in patients with soft tissue defects of foot and ankle.Methods A total of fifty patients with soft tissue defects of foot and ankle were selected as the research subjects.All of the patients were treated with the peroneal artery perforator pedicle propeller flap repair.During hospitalization,all of them received a comprehensive intervention and were followed up for 3 months.The clinical effect of the repair combined with the intervention was compared.The skin temperature on the first,second and third day after surgery was compared,and the American Orthopaedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score were recorded after 3 months of follow-up.Results All the 50 patients survived the flap transplantation.After 3 months of follow-up,there was no edema or rupture in the operation area of all the patients.The texture and color of the transplanted flaps were similar to the surrounding skin,with smooth pedicles and beautiful appearance.AOFAS scores:Foot alignment score (7.36±2.43),varus plus valus score (5.29±0.63),flexion plus extension score (7.43±0.42),ankle-hind foot stability score (6.83±0.57),maximum walking distance score (4.25±0.47),pain score (32.74±4.57),ground walking score (4.36±0.53),independent activity and support score (8.32±1.35),abnormal gait score (6.61±1.36),total score (83.19±5.83).After 3 months of follow-up,the Maryland Foot Score in 50 patients was (87.27±4.37),of which 31 were excellent and 19 were good.All patients recovered the deep sensation of the foot,the central sensation recovered to S^(3),the shallow sensation of the edge recovered better,the sensation of the edge recovered mostly to S^(4,and the shallow sensation of other operation areas recovered regionally,and the two-point discrimination was (20.16±2.31) mm.One day after operation,the skin temperature of 50 patients at the interval of 4 hours was higher than that at

关 键 词：足踝软组织缺损 腓动脉穿支蒂螺旋桨皮瓣 修复 综合干预 修复效果 

分 类 号：R658[医药卫生—外科学]