负压封闭引流联合携带骨膜的低位外踝上皮瓣在前足软组织缺损修复中的应用效果  

Effect of negative pressure wound therapy combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects

作　　者：连海鹏 王科 古雨浓 李建武 白国玺 李战宁 Lian Haipeng;Wang Ke;Gu Yunong;Li Jianwu;Bai Guoxi;Li Zhanning(No.2 Department of Orthopedics,Shaanxi Provincial Corps Hospital of the Chinese People's Armed Police Forces,Xi'an 710000,China)

机构地区：[1]武警陕西省总队医院骨二科,西安710000

出　　处：《国际医药卫生导报》2024年第18期3018-3022,共5页International Medicine and Health Guidance News

基　　金：陕西省重点研发计划(2022SF-211)。

摘　　要：目的探讨负压封闭引流联合携带骨膜的低位外踝上皮瓣修复前足软组织缺损的效果。方法本研究为随机对照试验。选取2020年2月至2023年2月武警陕西省总队医院收治的92例前足软组织缺损患者,采用摸球法分组,奇数为对照组(46例),偶数为观察组(46例)。对照组男25例,女21例,年龄(38.69±3.25)岁,机械损伤24例,车祸伤17例,压砸伤5例,予以传统清创联合携带骨膜的低位外踝上皮瓣修复治疗;观察组男24例,女22例,年龄(38.51±3.12)岁,机械损伤25例,车祸伤15例,压砸伤6例,予以负压封闭引流联合携带骨膜的低位外踝上皮瓣修复治疗,两组均随访6个月。比较两组临床相关指标、皮瓣成活率、疼痛程度[视觉模拟评分法(VAS)]、踝关节功能[美国足踝外科协会踝-后足评分系统(AOFAS)]、感觉功能、并发症发生情况。采用χ^(2)检验、t检验。结果观察组手术时间(44.96±4.25)min、抗生素使用时间(5.69±1.14)d、住院时间(18.98±2.87)d、换药次数(4.28±1.01)次、皮瓣切取面积(47.26±4.85)cm^(2),对照组分别为(61.02±5.69)min、(11.25±2.05)d、(28.65±3.16)d、(9.26±1.95)次、(55.36±5.12)cm^(2),差异均有统计学意义(t=12.753、16.464、16.251、12.355、8.309,均P<0.001)。术后6个月,观察组皮瓣成活总体优良率为95.65%(44/46),对照组为71.74%(33/46)],差异有统计学意义(χ^(2)=9.638,P=0.002)。治疗6个月后,观察组AOFAS评分高于对照组[(19.79±3.02)分比(16.02±2.84)分]、VAS评分低于对照组[(2.32±0.59)分比(4.21±0.85)分],差异均有统计学意义(t=6.168、12.389,均P<0.001)。术后6个月,观察组患者的感觉功能恢复效果优于对照组(χ^(2)=9.902,P=0.007)。观察组并发症总发生率低于对照组[6.52%(3/46)比21.74%(10/46)],差异有统计学意义(χ^(2)=4.389,P=0.036)。结论负压封闭引流联合携带骨膜的低位外踝上皮瓣修复治疗前足软组织缺损效果显著,可以缩短治疗时间,提高皮瓣存活率,减轻Objective To investigate the effect of negative pressure wound therapy(NPWT)combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects.Methods This study was a randomized controlled trial.A total of 92 patients with forefoot soft tissue defects admitted to Shaanxi Provincial Corps Hospital of the Chinese People's Armed Police Forces from February 2020 to February 2023 were divided into two groups by touching ball method,with odd numbers allocated to the control group(46 cases)and even numbers to the observation group(46 cases).In the control group,there were 25 males and 21 females,aged(38.69±3.25)years,including 24 cases of mechanical injury,17 cases of traffic injury,and 5 cases of crushing injury.In the observation group,there were 24 males and 22 females,aged(38.51±3.12)years,including 25 cases of mechanical injury,15 cases of traffic injury,and 6 cases of crushing injury.The control group was treated with traditional debridement combined with periosteum-carrying lower lateral malleolus flap repair,and the observation group was treated with NPWT combined with periosteum-carrying lower lateral malleolus flap repair.The clinical indicators,flap survival rate,pain degree[Visual Analogue Scale(VAS)],ankle function[American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale(AOFAS)],sensory function,and complications were compared between the two groups.χ^(2)test and t test were used.Results After treatment,the operation time of the observation group was(44.96±4.25)min,the antibiotic use time was(5.69±1.14)d,the hospital stay was(18.98±2.87)d,the dressing change times were(4.28±1.01),the flap harvest area was(47.26±4.85)cm^(2),and those of the control group were(61.02±5.69)min,(11.25±2.05)d,(28.65±3.16)d,(9.26±1.95),and(55.36±5.12)cm^(2),with statistically significant differences(t=12.753,16.464,16.251,12.355,and 8.309,all P<0.001).The overall survival rate of skin flap was 95.65%(44/46)in the observation group and 71.74%(33/46)in the control group,with

关 键 词：负压封闭引流 携带骨膜的低位外踝上皮瓣 前足软组织缺损 踝关节功能 感觉功能 

分 类 号：R658.3[医药卫生—外科学]