股外侧复合组织移植修复跟腱及周围软组织缺损  

Lateral femoral composite tissue transfer in reconstruction of defects of Achilles tendon and surrounding soft tissue

作　　者：代创国 王新宏 郑晓菊 李海军 张忠 王保山 Dai Chuangguo;Wang Xinhong;Zheng Xiaoju;Li Haijun;Zhang Zhong;Wang Baoshan(Department of Hand and Foot Microsurgery,Xi'an Fengcheng Hospital,Xi'an 710016,China)

机构地区：[1]西安凤城医院手足显微外科,西安710016

出　　处：《中华显微外科杂志》2025年第1期20-24,共5页Chinese Journal of Microsurgery

基　　金：西安市卫生健康委员会卫生科研人才项目(2020yb75)。

摘　　要：目的探讨对跟腱及周围软组织缺损的病例采用吻合血管的股外侧筋膜或加股前外侧皮瓣(ALTF)联合移植修复的临床效果。方法回顾性分析2004年5月-2021年12月,西安凤城医院手足显微外科对15例中2例跟腱断裂修复术后感染、13例跟腱缺损伴有不同程度周围软组织缺损的患者,用股外侧筋膜修复跟腱全部携带皮瓣一同修复,根据创面大小选择以ALTF和膝上外侧动脉皮瓣移植,10例携带ALTF,其中3例携带股外侧肌;5例膝外侧动脉皮瓣修复。跟腱缺损长度3.0~8.0 cm,切取阔筋膜长4.0~9.0 cm,皮瓣切取面积4.0 cm×3.0 cm~30.0 cm×18.0 cm。切取筋膜及皮瓣将筋膜卷起或包裹肌肉在屈膝30°、屈踝30°张力吻合,再行血管端端或端侧吻合。皮瓣覆盖创面。结果15例均成活,经2~5年随访提踵试验均为阴性,无跟腱再断裂,有2例行走略有跛行,余行走自如,跟腱区皮瓣无破溃等并发症发生,皮瓣均恢复保护性感觉;根据Amer-Lindholm评分标准评定:优13例、良2例。结论股外侧复合组织移植修复跟腱及周围组织缺损是有效的临床修复方法。Objective To investigate the clinical effect of the transfer of lateral femoral fascia or combined with anteriolateral thigh flap(ALTF)on treatment of defects of Achilles tendon and surrounding soft tissue.MethodsFrom May 2004 to December 2021,15 patients with Achilles tendons defects were treated with the transfer of either lateral femoral fascia or combined with ALTF in the Department of Hand and Foot Microsurgery,Xi'an Fengcheng Hospital.Two of the patients had postoperative infection after the primary treatment for Achilles tendon rupture and 13 patients had Achilles tendon defect together with various grade of defects of surrounding soft tissues.According to the size of wound,ALTFs and lateral superior knee flaps were used for the reconstructions.Various complex tissue flaps were used in reconstructive surgery:ALTF in 10 patients,the lateral thigh muscular flap in 3 patients and the lateral knee artery flap in 5 patients.The length of Achilles tendon defect was 3.0-8.0 cm and the length of fascia was 4.0-9.0 cm.The sizes of the flaps were 4.0 cm×3.0 cm-30.0 cm×18.0 cm.After the fascia and the flaps were harvested,the fascia was rolled up or wrapped up around the muscle with the knee at 30°flexion and the ankle at 30°flexion.Then end-to-end or end-to-side blood vessel anastomoses were carried out.The ALTFs were used to cover the wounds.ResultsAll the 15 flaps survived.After 2 to 5 years of follow-up,the heel lift test was found negative,without re-broken of Achilles tendon.All patients were in normal walking gait,except 2 patients who had mild lameness.According to the Amer-Lindholm scoring criteria,the results were excellent in 13 patients and good in 2 patients.ConclusionLateral thigh composite tissue transfer is an effective method to reconstruct Achilles tendon and the defects of its surrounding tissues.

关 键 词：跟建缺损 外科皮瓣 组织移植 修复 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]