| 刘 华,许春涛,颜丙祥,张 雷,邹 林,韩 康,赵 燕.腓肠神经营养血管皮瓣修复跟骨骨折术后皮肤软组织缺损的临床研究[J].,2022,(3):477-481 |
| 腓肠神经营养血管皮瓣修复跟骨骨折术后皮肤软组织缺损的临床研究 |
| Clinical Application of Sural Neurofasciocutaneous Flap in the Treatment of Repairing Soft Tissue Defect of Foot after the Operation of Calcaneal Fractur |
| 投稿时间：2021-06-04 修订日期：2021-06-27 |
| DOI：10.13241/j.cnki.pmb.2022.03.016 |
| 中文关键词: 跟骨骨折 软组织缺损 腓肠神经营养血管皮瓣 |
| 英文关键词: Calcaneal fracture Soft-tissue defect Sural neurovascular flap |
| 基金项目:国家自然科学基金项目（81702935） |
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| 中文摘要: |
| 摘要 目的：探讨负压引流技术结合腓肠神经营养皮瓣在跟骨骨折钢板内固定术后皮肤软组织缺损的临床效果。方法：回顾性分析我院骨科2012年5月-2020年5月共31例跟骨骨折术后钢板外露，皮肤软组织缺损住院病人。纳入患者均使用负压引流技术结合腓肠神经营养皮瓣修复技术。创面给予彻底清创后行封闭负压吸引引流术，待创面新鲜后以腓肠神经营养皮瓣修复创面。对术后皮瓣成活情况；Maryland功能评分以及BMRC感觉功能评分进行综合评估。结果：术后2周时，28例皮瓣顺利成活，供区与受区伤口愈合良好，干燥、无渗出。3例术后出现皮瓣肿胀，皮瓣颜色发暗，伤口渗出较多，皮瓣边缘坏死，窦道形成等，给予切开引流、加强换药、敏感抗生素控制感染等治疗后，皮瓣成活。术后随访6-24个月皮瓣外观及功能恢复良好，无创面再坏死，裂开，感染等情况出现。其中2例再次入院行皮瓣整形术。术后6个月时，Maryland功能评分：优：17例；良：11例；优良率为：90.3%。BMRC感觉功能评分：S3-S4：20例；S2：8例；S1：3例。结论：腓肠神经营养皮瓣联合封闭负压吸引技术在跟骨骨折钢板内固定术后皮肤软组织缺损的治疗中能够缩短治疗时间，操作简单，疗效确切，可获得良好的修复效果。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical effect of the VSD combined sural neurovascular flap in the treatment of soft-tissue defect of postoperative calcaneal fracture. Methods: A retrospective analysis was performed of 31 cases of oft-tissue defect and plate exposure after the surgery for calcaneal fractures from 2012.05 to 2020.05. All the patients underwent surgery using the VSD combined sural neurovascular flap. The wounds shall be given to thoroughly debrided and then be covered with VSD. After the wounds have become fresh, they wound be used the sural nerve flaps for repair. while 54 patients underwent surgery with conventional balloon dilatation vertebroplasty (PKP group). The VAS and ODI scores in 3days, 3 months after operations were analyzed. Standard thoracolumbar radiography was performed before and after operation. The imaging was compared before and after operation, including anterior edge height, posterior edge height, midline height and cobb angle. The bone cement distribution and the rate of bone cement leakage were evaluated of both groups. Results: After 2 weeks, 28 flaps survived completely without vascular problems. The donor site and wound were healed by first intention. 3 cases of the flaps have become swelling, dark color, edge necrosis, and sinus formation. These flaps wound be give incision, drainage, more dressing, and sensitive antibiotics to control infection, at last, all the flaps have become survival and all the patients were followed up for 6 to 24 months. The flap appearance and function were satisfactory, and the wound have no longer present necrosis, dehiscence, and infection. 2 cases were admitted to hospital for the second time having flap plastic surgery, and the effect was satisfactory. According to Maryland foot score, the skip flaps in 17 cases were excellent, 11 cases good; the excel good rate was 90.3%. The BMRC sensory function scores of the flaps were S3-S4 in 20 cases, S2 in 8 cases and S1 in 3 cases. Conclusion: The sural neurovascular flap combined VSD in the treatment of soft-tissue defect of postoperative calcaneal fracture wound save time, be sample for operation, and have good repairing effect. |
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