摘要
目的探讨腓骨头复合组织瓣重建小儿内踝骨质及皮肤缺损的临床疗效。方法采用回顾性病例系列研究分析2010年3月—2018年6月潍坊市益都中心医院收治的 5例内踝骨及皮肤软组织缺损患儿临床资料,其中男3例,女2例;年龄3~12岁;右侧3例,左侧2例。均为内踝缺损,伴有邻近皮肤缺损。皮肤缺损范围3.0cm×3.5 cm^6.0 cm×10.5 cm;骨缺损范围1.0 cm×1.0 cm^2.0 cm×3.0 cm。设计腓骨头复合组织瓣Ⅰ期重建内踝及其邻近软组织缺损。供区4例直接缝合,1例植皮修复。观察皮瓣外观、质地、弹性及颜色是否与周围近似,双下肢是否等长,关节有无畸形、踝关节活动度及膝、踝关节功能[依据美国足踝外科学会(AOFAS)制定的足踝功能评价标准],影像学改变,供区膝关节有无畸形发生,有无疼痛和腓总神经支配区感觉异常,是否影响膝关节屈伸活动。结果术后复合组织瓣均成活,无血运障碍,创面均Ⅰ期愈合。所有患儿随访6~30个月,平均21个月,皮瓣外形较美观,质地、弹性及颜色与周围近似,无瘢痕挛缩,双下肢等长。踝关节无畸形,手术前后踝关节活动度对比,背伸术前为(4.4±1.1)°,末次随访为(13.2±2.4)°(P<0.05);跖屈术前为(12.4±1.8)°,末次随访为(34.8±4.8)°(P<0.05)。依照AOFAS足踝功能评判标准评估:优3例,良2例。X线片显示踝穴间隙及内踝纵向发育状况与健侧肢体大致同步,无关节磨损征象,内踝骨骺无早期闭合,骨化中心逐步增大或明显。供区膝关节均无畸形发生,无疼痛和腓总神经支配区感觉异常出现,膝关节屈伸活动无影响。结论腓骨头复合组织瓣能够Ⅰ期重建小儿内踝骨骺及邻近软组织缺损,外观恢复较好,踝关节功能恢复,重建的内踝与小儿的生长发育过程同步,且对供区膝关节功能及感觉无影响,是重建小儿内踝缺损的较好方式之一。
Objective To investigate the therapeutic effect of the fibular head composite flaps for reconstruction of bone and skin defect at medial malleolus in children.Methods A retrospective case series study was conducted to analyze 5 children(3 males and 2 females,aged 3-12 years)with internal malleolus and skin soft tissue defects admitted to the Yidu Central Hospital of Weifang between March 2010 and June 2018.The medial malleolus was defected(3 children at the right foot and 2 at the left foot)combined with skin defect around the medial malleolus.Dimension of skin defect was 3.0 cm×3.5 cm to 6.0 cm×10.5 cm,and of bone defect was 1.0 cm×1.0 cm to 2.0 cm×3.0 cm.The complex of the vascularized fibular head epiphysis was adopted to repair the defects at one stage.The donor sites were repaired with direct suture in 4 children and with skin graft in 1.Appearance,texture,elasticity and color of the flaps,length of lower limbs,ankle joint deformity,ankle joint range of motion,function of knee and ankle joint evaluated by using American Orthopedic Foot and Ankle Society(AOFAS)score and image change were observed.The flap donor area was evaluated for deformity,pain and sensory abnormality in the common peroneal nerve innervation area,and range of motion.Results All the composite tissue flap survived with good blood circulation,and the wound healed by first intention.All children were followed up for 6-30 months(mean,21 months).The appearance of the flap was good,and the texture,elasticity and color were similar to the surrounding area,without cicatricial contracture.The legs were the same length,and there was no deformity of the ankle joint.None had ankle joint deformity,with satisfactory loading and walking function.Comparison of ankle movement before and after operation showed significant differences:dorsal extension angle[(4.4±1.1)°vs.(13.2±2.4)°],plantar flexion angle[(12.4±1.8)°vs.(34.8±4.8)°](both P<0.05).Three children were graded as excellent and two good according to AOFAS score.X-ray showed that the gap between ankle acupoints and longitudinal development of the medial malleolus were almost synchronized with the healthy limbs.No signs of joint wear or early closure of epiphysis of medial malleolus was observed,and ossification center was obvious or showed gradually increase.The donor knee joint had normal flexion and extension function,without deformity,pain,or abnormal sensation in the common peroneal nerve innervation area.Conclusions The complex of vascularized fibular head epiphysis and tissue flap can repair the bone and adjacent soft tissue defect of the medial malleolus in children at one stage,with good appearance recovery and ankle joint function recovery.The reconstructed medial malleolus can develop with the growth of children and has no effect on the function and feel of the knee joint in the donor area.It is a satisfactory method of reconstructing the traumatic defect of medial malleolus in children.
作者
范晓华
夏海
刘晓云
方军
Fan Xiaohua;Xia Hai;Liu Xiaoyun;Fang Jun(Joint Trauma Department of Orthopedic,Yidu Central Hospital of Weifang,Weifang 262500,China;Department of Cardiology,Yidu Cenral Hospital of Weifang,Wejfang 262500,China;Department of Spine Orthopedic Trauma,Yidu Central Hospital of Weifang,Weifang 262500,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第2期172-177,共6页
Chinese Journal of Trauma
关键词
儿童
踝损伤
腓骨
复合组织瓣
Child
Ankle injuries
Fibula
Compound tissue flap
