摘要
目的探讨跟腱及周围复合组织缺损的显微外科修复方法及临床效果。方法自1994年6月至2011年3月，对356例跟腱伴周围复合组织缺损的患者采用不同的显微外科方法的治疗。根据跟腱缺损长度及周围软组织缺损情况分为A和B两类。A类为跟腱缺损在3cm以内、皮肤缺损在3cm×20cm以内，采用跟腱直接缝合（166例）或Abraham倒“V-Y”腱成形术（72例）修复跟腱损伤，采用局部皮瓣转移（238例）修复周围软组织缺损。其中跟外侧皮瓣转移修复23例，足底内侧皮瓣转移修复58例，足背皮瓣转移修复40例，内踝上皮瓣转移修复48例，外踝上皮瓣转移修复24例，腓肠神经营养血管皮瓣转移修复29例，腓肠肌皮瓣推移修复修复16例。B类为跟腱缺损超过3cm、皮肤缺损在3cm×20cm以上，跟腱难以直接缝合，则采用吻合血管的复合组织瓣一期修复跟腱和软组织缺损（118例）。其中阔筋膜张肌皮瓣移植修复52例，膝上外侧复合组织瓣移植修复26例，背阔肌筋膜组织瓣移植修复24例，腹直肌前鞘肌皮瓣移植修复16例。结果临床应用356例，局部皮瓣转移238例中226例全部成活，12例部分成活，经换药后伤口愈合。游离组织瓣118例中109例全部成活，8例术后发生血管危象，经手术探查后成活，1例手术失败，改用其他组织瓣后存活。随访1．0～4．5年，平均3．2年，按Ther—mann功能评定：优240例，良86例，可22例，差8例，优良率91．6％。结论显微外科技术是修复跟腱伴周围复合组织缺损的优良方法，根据跟腱及周围复合组织缺损程度灵活选择不同的修复方法，可以达到良好的功能恢复目的。
Objectives To approach the method and clinical effect on tendo calcaneus and complex tis-sue defect with microsurgery repair. Methods Retrospective summary the methods of 356 cases with tendo ealcaneus and complex tissueserious defect, which repaired by different microsurgery from June 1994 to March 2011. Two type were divided on account of different degree of serious tendo calcaneus and complex tissue de-fect. Type A ： the length of tendo calcaneus defect was less than 3 cm, and cutaneous deficiency is less than 3 cm × 20 era. Direct suture （ 166 cases） or Abraham retrograde ＂V-Y＂ method （ 72 cases） was used to repair endo calcaneus defec, anfregional flap metastasis was used to repair cutaneous deficiency. Two hundred and thirty- eight cases were used by those methods, including of lateral heel flap repair（23 cases） , medial plantar island flap（58 cases） , instep island flap（40 cases） , above medial malleolus flap（48 cases） , above ateral malleolus flap （24 cases）, sural nerve nutrient vessel flap （ 29 cases） gastrocnemius muscle flap （ 16 cases）. Type B ： the length of tendo calcaneus defect was more than 3 era, and cutaneous deficiency was more than 3 cm x 20 era. Direct suture could not repair tendo calcaneus, the complex tissue flap free grafting was used to primary repair tendo ealcaneus and complex tissue defect. One hundred and erghteen cases were used by those methods,inclu- ding of tensor fasciae latae flap free grafting （52 cases） , lateral above knee complex tissue flap free grafting （26 cases）, latissimus dorsi muscle fascia flap free grafting （24 cases）, rectus abdominis muscle front sheath flap free grafting （16 cases） . Three hundred and fifty-six cases were repaired by these methods, including 238 ca-ses of regional flap transfer 118 cases of tissue flap free grafting, Results In 238 cases of regional flap trans-fer, two hundred and twenty-six cases were successful, and 12 cases were partly success, which were wound healing by change dressings. In 118 cases of tissue flap free grafting, one hundred and nine cases were success-ful, and blood vesse articulo were happened to 8 casess, which were success by operations research, and 1 case was failure which had to use another tissue flap. Follow-up visit was dane from 1.0 year to 4. 5 years after opera- tion （ average 3.2 years）. Functional assessment according to the Thermann ralted the resu｜ts as excellent in 240 csaes, good in 86 cases, common in 22 cases and worse in 8 cases. The fineness rate was 91.6%. Con-clusion Microsurgical repair is a good method to tendo calcaneus and complex tissue defect, different method and strategy selected actively by tissue defect degree of tendo calcaneus and complex tissue can achieve satisfactory functional rehabilitation purpose.
出处
《中华显微外科杂志》
CSCD
北大核心
2013年第2期129-132,共4页
Chinese Journal of Microsurgery
关键词
跟腱
组织缺损
皮瓣移植术
显微外科
Achilles tendon
Tissue defect
Flap grafting
Microsurgery
