皮瓣移植联合同种异体肌腱一期修复跟腱及周围软组织复合缺损  

Flaps transfer with allogeneic tendon transplantation in reconstruction of composite defect of Achilles tendon and surrounding soft tissue

作　　者：陈江伟[1] 林尊文[1] 黄跟东[1] 钟骏龙 肖忠洲 刘志礼[1] 邓葵[1] CHEN Jiangwei;LIN Zunwen;HUANG Gendong;ZHONG Junlong;XIAO Zhongzhou;LIU Zhili;DENG Kui(Department of Orthopaedics,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院骨科,南昌330006

出　　处：《中华显微外科杂志》2023年第5期522-526,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨皮瓣移植联合同种异体肌腱一期修复跟腱及其周围软组织复合缺损的手术方法和临床效果。方法自2018年7月至2022年8月,南昌大学第一附属医院骨科应用皮瓣移植联合同种异体肌腱一期修复跟腱及其周围软组织复合缺损12例,男9例,女3例,年龄8~56岁,平均31.5岁。跟腱缺损长4.0~9.0 cm,软组织缺损面积3.0 cm×4.0 cm~14.0 cm×6.0 cm,所有病例均应用同种异体肌腱移植修复跟腱缺损,行腓肠神经营养血管皮瓣6例,腓动脉穿支皮瓣3例,游离股前外侧皮瓣(ALTF)3例,皮瓣面积4.0 cm×4.5 cm~15.0 cm×7.0 cm,供区直接拉拢缝合或植皮覆盖。术后定期复查,出院后通过门诊、电话及微信定期随访,观察皮瓣成活、踝关节及跟腱功能恢复情况。结果随访3个月~2年,平均13个月。本组所有病例均未出现明显排斥反应。12例皮瓣全部成活,皮瓣颜色和质地与周围皮肤接近,供区和受区均无溃疡发生。无跟腱再次断裂病例,末次随访踝关节活动度为背伸(13.4±2.6)°,跖屈(33.6±3.2)°;依据美国矫形足踝外科协会(AOFAS)踝与后足功能评分标准评分为(88.7±5.6)分,其中优7例,良4例,可1例。结论对于跟腱及其周围软组织复合缺损的患者,应用皮瓣移植联合同种异体肌腱一期修复,疗效满意,创伤小,并发症少,是一种可行的修复方法。Objective To investigate the clinical efficacy in one stage reconstruction of composite defects of Achilles tendon and surrounding soft tissues with a flap transfer combined with allogeneic tendon transplantation.Methods From July 2018 to August 2022,a total of 12 patients,including 9 males and 3 females,with a mean age of 31.5(ranged 8 to 56)years old,had surgery with flap transfer combined with transplantation of allogeneic tendon in one stage reconstruction for compound defects of Achilles tendon and soft tissue at the Department of Orthopaedics of First Affiliated Hospital of Nanchang University.The defects of Achilles tendons ranged from 4.0 to 9.0 cm,and the soft tissue defects sized from 3.0 cm×4.0 cm to 14.0 cm×6.0 cm.Of the 12 patients,6 received transfers of sural neurovascular flaps,3 with peroneal perforator flaps and 3 with free anterolateral thigh flaps(ALTF).The flaps sized from 4.0 cm×4.5 cm to 15.0 cm×7.0 cm,and in addition,allogeneic tendon grafts were used to reconstruct the defects of Achilles tendons in all patients.All the flap donor sites were either directly sutured or covered with skin grafts.Follow-up was carried out by visits of outpatient clinic or telephone or WeChat distant interviews.The flap survival and recovery of ankle function and Achilles tendon were observed.Results During the 3 months to 2 years of follow-up,none of the patient showed obvious immunological rejection against the transplanted allogeneic tendon.All 12 flaps survived well with the colour and texture close to the surrounding skin.No ulceration occurred in both of the donor and recipient sites.There was no re-rupture of the transplanted allogeneic tendon.At the final follow-up,ankle movement was measured at 13.4°±2.6°in dorsal extension and 33.6°±3.2°in plantar flexion.According to American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hind foot function score,a score of 88.7±5.6 was achieved with 7 patients in excellent,4 in good and 1 was acceptable.Conclusion In patients with a composite defect

关 键 词：肌腱移植 同种异体 外科皮瓣 跟腱缺损 软组织缺损 

分 类 号：R687.2[医药卫生—骨科学]