摘要
目的探讨在三维CT血管造影(three-dimensional CT angiography,3D-CTA)技术的辅助下,游离腓骨复合组织瓣移植修复下肢复合组织缺损的临床效果。方法自2013年5月至2018年2月设计切取腓骨复合组织瓣修复下肢严重创伤患者16例,术前行供区3D-CTA检查明确腓动脉的走行、分布状况及有无血管变异。术后观察皮瓣的存活状况及外观,分别于术后6周、3个月、6个月、1年行X线片检查了解骨折愈合状况并评估患肢的功能恢复状况。结果3D-CTA技术能够明确复合组织瓣的解剖学结构,术中所见与术前设计基本一致。术后随访6-24个月,平均13个月,移植皮瓣均存活,骨折端愈合良好。依照Enneking系统评分:平均22分,平均恢复肢体功能的73%.供区踝关节活动正常,腓总神经支配区感觉无异常。结论游离复合组织瓣一次性修复骨缺损的同时,合并的皮瓣可同期修复软组织缺损,有效解决创面覆盖问题,恢复患肢功能,患者对预后满意。
Objective To investigate the clinical efficacy of free fibula composite tissue flap transplantation for repair of composite tissue defects of lower extremity assisted by three-dimensional CT angiography (3D-CTA). Methods From May 2013 to February 2018, 16 patients with severe lower extremity trauma were treated with fibular composite tissue flaps. The course, distribution and vascular variation of peroneal artery were determined by preoperative 3D-CTA. The survival and appearance of the flaps were observed after the operation. X-ray examination was performed 6 weeks, 3 months, 6 months and 1 year after the operation to observe the healing of the fracture and evaluate the functional recovery of the affected limbs. Results The anatomical structure of composite tissue flaps can be clearly displayed by 3D-CIA. The findings during operation were basically consistent with the preoperative design. The follow-up period ranged from 6 to 24 months, with an average of 13 months. All the flaps survived and the fracture healed well. According to Enneking system score the average point was 22. The lower extremity function recovered to 73% of that of the normal side. Ankle joint activity was normal in donor area, and there was no abnormal sensation in common peroneal nerve innervation area. Conclusion At the same time of repairing bone defects with free composite tissue flaps, the combined skin flaps can repair soft tissue defects, which effectively solve the problem of wound coverage and restore the function of affected limbs. The patients are satisfied with the prognosis.
作者
田振欣
时丹萍
姜宁宁
王建国
刘兴龙
Tian Zhenxin;Shi Danping;Jiang Ningning;Wang Jianguo;Liu Xinglong(Department of Hand and Foot Surgery,Yidu Central Hospital of Weifang,Shandong 262500,China;Department of Traumatic Orthopedics,Affiliated Hospital of Weifang Medical College,Shandong 261031,China)
出处
《中华手外科杂志》
CSCD
北大核心
2019年第5期373-376,共4页
Chinese Journal of Hand Surgery
关键词
下肢
治疗结果
三维CT血管造影
腓骨复合组织瓣
Lower extremity
Treatment outcome
Three-dimensional CT angiography
Fibula composite tissue flap
