摘要
目的探讨带蒂肌皮瓣联合改良Masquelet技术修复糖尿病患者胫骨与软组织缺损的疗效和适应证。方法回顾性分析2017年1月-2019年10月采用带蒂肌皮瓣联合改良Masquelet技术修复的20例糖尿病伴胫骨与软组织缺损患者的资料。男13例,女7例;年龄40〜65岁,平均51岁。术前下肢动脉超声及CTA证实胫前、胫后动脉通畅无闭塞。病灶清除后骨缺损长4~9 cm,软组织缺损范围3 cm×6 cm~7 cm×10 cm,分别填塞抗生素骨水泥。7~10 d后取出骨水泥,新的骨水泥仅填塞骨缺损部位,同时行带蒂肌皮瓣修复创面,间隔8~12(平均9)周行Masquelet技术第二阶段手术。术后定期随访,记录创面和骨缺损愈合以及并发症情况。至术后12个月,皮瓣愈合和外观按张浩等标准评价,患肢功能恢复按Johner-Wruhs标准评价,症状消失无复发者视为治疗成功。结果均获13~28(平均20)个月随访。骨缺损均愈合,愈合时间6~11个月,平均9个月。肌皮瓣均成活,创面延期愈合2例,I期愈合18例;皮瓣形态9例接近正常,11例臃肿;皮瓣感觉17例部分存在,3例无感觉;皮瓣温度7例正常,13例稍低;供区瘢痕14例为轻,6例明显;所有患者疗效均为满意。2例术后感染复发。术后12个月,患肢功能恢复优良率、感染控制率和治疗成功率均为90%(18/20)。结论带蒂肌皮瓣联合改良Masquelet技术修复符合适应证的糖尿病患者胫骨与软组织缺损,短中期效果良好。
Objective To investigate the effect and indications of pedicled myocutaneous flap and modified Masquelet technique in the repair of diabetic soft tissue and tibial bone defects.Methods From January,2017 to October,2019,data of surgical treatment of 20 patients with diabetic soft tissue and tibial bone defects were retrospectively studied.The detects were repaired by the pedicled myocutaneous flap combined with modified Masquelet technique.There were 13 males and 7 females aged 40 to 65(average 51)years old.Preoperative ultrasound and CTA had confirmed that there was no occlusion in anterior and posterior tibial arteries.After debridement,the bone defect was 4-9 cm in length and the soft tissue defect was 3 cmx6 cm to 7 cm×1O cm.The initial antibiotic loaded bone cement filling of the bone and soft tissue defects was carried out.Then at 7-10 days later,had the bone cement placed earlier removed the remaining spaces of bone defect were again filled by antibiotic loaded bone cement.Meanwhile,the pedicled myocutaneous flap was transferred to repair the wound.The second stage of Masquelet technique was performed later,with an interval of 8-12(mean 9)weeks.The healing of wound and bone defect,and the complications were recorded.At 12 months after the surgery,the healing and appearance of the flap were evaluated by the standard proposed by Zhang Hao,and the functional recovery of the adjacent joint was evaluated by Johner-Wruhs standard.The treatment was considered successful when the symptoms were disappeared and no recurrence occurred.Results All patients entered 13 to 28 months of follow-up,20 months in average.The healing time for bone defect was 6-11(average 9.0)months.All myocutaneous flaps survived with 18 flaps healed in the stage one and 2 delayed healing.Nine flaps appeared almost normal and 11 shown bloating.Seventeen flaps were found with partial sensation and 3 without sensation at all.The temperature of 7 flaps was found normal and 13 were slightly lower.Fourteen donor site scars were mild and 6 were obvious.The overall curative effect was satisfactory.Two patients had recurred infection.The rates of excellent and good functional recovery,infection control and success of treatment were at 90%(18/20)for each.Conclusion Pedicled myocutaneous flap combined with modified Masquelet technique can repair diabetic soft tissue and tibial bone defects.It has a good therapeutic effect for short and medium terms.
作者
卜凡玉
薛明宇
邓鑫鑫
王进
郭晓峰
金磊
殷渠东
BU Fanyu;XUE Mingyu;DENG Xinxin;WANG Jin;GUO Xiaofeng;JIN Lei;YIN Qudong(Department of Wound Repair Surgery,Wuxi 9th People's Hospital Affiliated to Soochow University,Wuxi,Jiangsu Province 214062,China;Department of Orthopaedics,Wuxi Hongqiao Hospital,Wuxi,Jiangsu Province 214000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2021年第4期392-397,共6页
Chinese Journal of Microsurgery
基金
无锡市卫健委适宜技术推广项目(T201755)
无锡市政府太湖人才计划项目(2020WXTH-14)。
