早期康复训练在足踝软组织缺损游离皮瓣修复术后的临床观察  

Clinical observation of early rehabilitation training after free flap repair of foot and ankle soft tissue defects

作　　者：李小兵 刘洪均 杨超 江波 王雪 颜洪 熊爱兵 LI Xiaobing;LIU Hongjun;YANG Chao;JIANG Bo;WANG Xue;YAN Hong;XIONG Aibing(Department of Plastic and Burn Surgery,Affiliated Hospital of Southwest Medical University,National Key Clinical Construction Specialty,Luzhou 646000,China;Department of Plastic,Aesthetic and Reconstructive Surgery,West China Second University Hospital,Sichuan University,Chengdu 610000,China.)

机构地区：[1]西南医科大学附属医院整形烧伤外科,国家临床重点建设专科,四川省泸州市646000 [2]四川大学华西第二医院整形美容修复重建科,四川省成都市610000

出　　处：《组织工程与重建外科》2025年第2期125-129,161,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：(泸州-医科大)合作项目(项目编号:2019LZXNYDZ08)。

摘　　要：目的探索游离皮瓣修复足踝软组织缺损后,早期康复训练对足踝关节功能康复的临床疗效。方法选择我科2018年1月至2022年1月收治的足踝软组缺损患者共32例,均采用游离皮瓣移植修复。以游离皮瓣移植后未行康复治疗的患者作为对照组,共15例;游离皮瓣移植后进行早期康复训练患者作为观察组,共17例。所有患者组织缺损创面均累及踝关节皮肤,且伴有肌腱及骨外露。患者创面清创后面积为7.0 cm×3.0 cm~25.0 cm×23.0 cm,移植股前外测游离皮瓣修复创面,皮瓣切取面积为9.0 cm×4.0 cm~27.0 cm×15.0 cm。术后记录皮瓣存活情况、皮瓣移植术后创面痊愈时间以及并发症发生情况。观察组术后4天开始进行患足康复训练,直至患者出院。以美国矫形外科足踝协会AOFAS评分系统,评价患足术前、术后3周及术后半年的足踝功能。采用Barthel指数对患者术前、术后3周及术后6个月的日常生活活动能力(ADL)进行评估。同时在术后6个月记录患者满意度。结果32例皮瓣全部存活,观察组与对照组各有2例皮瓣边缘部分坏死,经换药后植皮痊愈。观察组皮瓣移植术后创面痊愈时间(16.35±2.83)天,少于对照组愈合时间(18.67±3.22)天(P<0.05)。所有患者皮瓣质地、外观良好,均未行二期瘢痕及关节松解,随访期间均未发生皮肤溃疡、截肢或者死亡。观察组术前足踝功能AOFAS评分、ADL评分与对照组差异均无统计学意义(P>0.05)。术后3周、术后6个月,观察组足踝功能AOFAS评分、ADL评分均显著高于对照组(P<0.05)。观察组患者满意度稍高于对照组,但差异无统计学意义(Z=-0.937,P>0.05)。结论足踝软组织损伤游离皮瓣移植术后早期康复训练的介入,可明显改善患者足踝关节功能,提高患者日常生活自理能力,具有长期效果。Objective To explore the clinical effect of early rehabilitation training of foot and ankle joint after repairing soft tissue defect with free flap.Methods A total of 32 patients with foot and ankle soft tissue defects who were treated in our department from January 2018 to January 2022 were selected.The control group included 15 patients who did not receive rehabilitation treatment after free flap transplantation.The observation group consisted of 17 patients who received early rehabilitation training after free flap transplantation.The tissue defect wound of all patients involved ankle joint skin,accompanied by tendon and bone exposure.The area of the patient’s wound after debridement was 7.0 cm×3.0 cm~25.0 cm×23.0 cm,and the femoral anterolateral free flap was transplanted to repair the wound.The area of skin flap was 9.0 cm×4.0 cm~27.0 cm×15.0 cm.The survival of the flap,the healing time of the wound after flap transplantation and the occurrence of complications were recorded.The patients in the observation group began the rehabilitation training of the affected foot 4 days after operation until they were discharged from hospital.AOFAS scoring system of American Orthopedic Foot and Ankle Association was used to evaluate the function of foot and ankle before operation,3 weeks after operation and 6 months after operation.Barthel index was used to evaluate the activity of daily living(ADL)of patients before operation,3 weeks after operation and 6 months after operation.At the same time,patient satisfaction was recorded 6 months after operation.Results All the 32 flaps survived,while 2 cases in the observation group and 2 cases in the control group had partial tissue necrosis at the edge of the flap,and recovered after dressing change.The wound healing time of the observation group was(16.35±2.83)days,which was less than that of the control group(18.67±3.22)days(P<0.05).All patients had good skin flap texture and appearance,and no secondary scar and joint release surgery was performed.No skin ulcers,amput

关 键 词：康复治疗 软组织缺损 游离皮瓣 创面修复 足踝功能 

分 类 号：R687.2[医药卫生—骨科学]