应用低旋转点逆行外踝上皮瓣修复跟骨骨折术后皮肤软组织坏死缺损疗效分析
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摘要
目的:探讨跟骨骨折术后皮肤软组织坏死缺损应用低旋转点逆行外踝上皮瓣修复的治疗效果。方法:选取2012年1月-2016年12月收治的行跟骨骨折手术治疗后切口处发生皮肤软组织损伤患者100例,根据切口皮肤软组织缺损的修复方法不同分为观察组和对照组,每组50例。观察组采用低旋转点逆行外踝上皮瓣修复对跟骨骨折术后皮肤软组织坏死缺损进行修复,对照组予以传统腓肠神经营养血管逆行岛状皮瓣修复对跟骨骨折术后皮肤软组织缺损进行修复。观察两组术中出血量、手术时间及小腿皮瓣供区损伤程度,治疗后血管危象、皮瓣远端皮肤浅表坏死、治疗效果。结果:两组手术时间、术中出血量、血管危象、皮瓣远端皮肤浅表坏死、治疗成功率比较,差异均无统计学意义(P>0.05);观察组手术切口近端距离外踝尖距离显著少于对照组,差异有统计学意义(P<0.05)。结论:低旋转点逆行外踝上皮瓣是修复跟骨骨折术后皮肤软组织坏死缺损及钢板外露的较良好的治疗方法,临床应用前景广阔。
Objective:To evaluate the effect of low rotation point retrograde medial malleolus flap on the repair of skin and soft tissue necrosis after calcaneal fracture.Method:A total of 100 cases of skin and soft tissue injury occurred at the incision of calcaneal fractures were selected from January 2012 to December 2016 and were divided into the observation group and the control group according to the method of repairing the skin and soft tissue defect,50 cases in each group.The observation group was treated with low rotation point retrograde medial malleolus flap to repair the skin and soft tissue necrosis defect after calcaneal fractures,the control group was treated with traditional sural nerve nutrition vessel reverse island flap for calcaneal fracture postoperative skin and soft tissue defects.Intraoperative blood loss,operation time and calf flap for the degree of injury,vascular crisis after treatment,flap distal skin superficial necrosis and treatment effect of two groups were observed.Result:There were no significant differences in intraoperative blood loss,operation time,vascular crisis after treatment,flap distal skin superficial necrosis and treatment effect of two groups(P>0.05);the distance of the proximal incision near the lateral incision of the observation group was significantly less than that of the control group,the difference was statistically significant(P<0.05).Conclusion:The application of low rotation point retrograde medial malleolus flap in repairing the soft tissue necrosis of the skin and the exposed treatment of the steel plate after the operation of the calcaneal fracture has a bright future.
Objective:To evaluate the effect of low rotation point retrograde medial malleolus flap on the repair of skin and soft tissue necrosis after calcaneal fracture.Method:A total of 100 cases of skin and soft tissue injury occurred at the incision of calcaneal fractures were selected from January 2012 to December 2016 and were divided into the observation group and the control group according to the method of repairing the skin and soft tissue defect,50 cases in each group.The observation group was treated with low rotation point retrograde medial malleolus flap to repair the skin and soft tissue necrosis defect after calcaneal fractures,the control group was treated with traditional sural nerve nutrition vessel reverse island flap for calcaneal fracture postoperative skin and soft tissue defects.Intraoperative blood loss,operation time and calf flap for the degree of injury,vascular crisis after treatment,flap distal skin superficial necrosis and treatment effect of two groups were observed.Result:There were no significant differences in intraoperative blood loss,operation time,vascular crisis after treatment,flap distal skin superficial necrosis and treatment effect of two groups(P>0.05);the distance of the proximal incision near the lateral incision of the observation group was significantly less than that of the control group,the difference was statistically significant(P<0.05).Conclusion:The application of low rotation point retrograde medial malleolus flap in repairing the soft tissue necrosis of the skin and the exposed treatment of the steel plate after the operation of the calcaneal fracture has a bright future.
引文
[1]马辉,孙建强.应用低旋转点逆行外踝上皮瓣修复跟骨骨折术后皮肤软组织坏死缺损疗效分析[J].中国实用医药,2011,6(9):93-94.
[2]万强,赵云珍,何贤标,等.带双套血供的外踝上皮瓣修复足背皮肤缺损的临床应用[J].中华显微外科杂志,2016,39(2):172-174.
[3]黄伟雄,王明月,季鹏,等.改良外踝上皮瓣修复前足背皮肤软组织缺损[J].中华显微外科杂志,2015,38(4):401-403.
[4]张君哲,王晓桐,杜海山,等.SandersⅢ型跟骨骨折手术中防治皮肤坏死的疗效观察[J].中国医学创新,2012,9(22):93-94.
[5]王子田,陆野,韩健,等.改良外踝上皮瓣修复足背远端皮肤软组织缺损的疗效观察[J].中国骨与关节损伤杂志,2015,30(8):856-858.
[6]刘铁英,杨铭,胡金秋,等.腓肠神经营养血管皮瓣的解剖特点与逆行应用[J].中国医学创新,2012,9(25):154-155.
[7]黄铿,舒申友,谢扬,等.胫后动脉穿支皮瓣修复足踝部组织缺损12例[J].中华显微外科杂志,2014,37(4):387-388.
[8]尚博.跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系[J].实用临床医药杂志,2014,18(19):66-69.
[9]梁英杰,张光明,杨运发,等.腓肠神经营养血管逆行岛状皮瓣修复肢体远端皮肤缺损的临床应用[J].中国医学创新,2013,10(4):105-106.
[10]郑润泉,邹林,陈晨,等.邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效[J].骨科,2017,8(1):12-15.
[11]徐衍斌,初海坤,初海鹏,等.SandersⅣ型跟骨骨折治疗体会[J].中国医学创新,2012,9(11):37-39.
[12]朱学敏,唐三元,杨辉,等.跟骨骨折的微创治疗现状[J].生物骨科材料与临床研究,2014,11(1):31-34.
[13]赵旭,张连民.VSD封闭式负压引流在创伤性皮肤、软组织缺损中的应用及护理[J].中国医学创新,2012,9(17):156-157.
[14]罗长奇,方跃,屠重棋,等.闭合性跟骨骨折手术部位感染的危险因素分析[J].中华创伤骨科杂志,2016,18(12):1096-1099.
[15]雷林革,何如祥,王开栋,等.远端蒂腓肠神经营养血管皮瓣修复足踝及踝上组织缺损的临床应用[J].兰州大学学报(医学版),2014,40(1):45-49,53.
[16]肖海涛,李永林,钱汉根,等.穿支血管蒂皮瓣在臀区多部位难愈性创面修复中的应用[J].中华整形外科杂志,2009,25(1):11-13.
[17]杨国涛,李云龙,陈金亮,等.小腿旋转推进穿支皮瓣修复踝部创伤性溃疡18例[J].中华烧伤杂志,2015,31(6):464-465.
[18]潘敬舜,刘生和.改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用[J].创伤外科杂志,2016,18(4):214-216.
[19]康庆林,贾亚超,王亚洲,等.序贯式带蒂皮瓣修复足踝部皮肤缺损[J].中华显微外科杂志,2015,38(6):561-564.
[20]吴艳,吴明珑,吴丽,等.踝足部软组织缺损患者腓肠肌穿支皮瓣修复术后悬吊抬高的做法与体会[J].护理学报,2016,23(11):56-57.
[21]王海峰,朱捷,赵光勋,等.封闭负压引流结合穿支蒂皮神经营养血管皮瓣治疗足踝部创面[J].中国骨与关节损伤杂志,2014,29(12):1239-1241.
[22]段崇锋,焦涛,任孝燕,等.胫后动脉内踝上穿支蒂隐神经营养血管逆行岛状皮瓣修复足背及踝部软组织缺损[J].实用手外科杂志,2016,30(3):312-313,315.
[23]付记乐,高峻青,何斌,等.携带腓肠肌的胫后动脉穿支皮瓣修复足踝部腔隙性软组织缺损[J].中华显微外科杂志,2015,38(4):408-410.
[24]王道明,曾荣铭,余榕,等.皮瓣修复踝关节周围软组织缺损的疗效观察[J].实用手外科杂志,2016,30(3):309-311.
[2]万强,赵云珍,何贤标,等.带双套血供的外踝上皮瓣修复足背皮肤缺损的临床应用[J].中华显微外科杂志,2016,39(2):172-174.
[3]黄伟雄,王明月,季鹏,等.改良外踝上皮瓣修复前足背皮肤软组织缺损[J].中华显微外科杂志,2015,38(4):401-403.
[4]张君哲,王晓桐,杜海山,等.SandersⅢ型跟骨骨折手术中防治皮肤坏死的疗效观察[J].中国医学创新,2012,9(22):93-94.
[5]王子田,陆野,韩健,等.改良外踝上皮瓣修复足背远端皮肤软组织缺损的疗效观察[J].中国骨与关节损伤杂志,2015,30(8):856-858.
[6]刘铁英,杨铭,胡金秋,等.腓肠神经营养血管皮瓣的解剖特点与逆行应用[J].中国医学创新,2012,9(25):154-155.
[7]黄铿,舒申友,谢扬,等.胫后动脉穿支皮瓣修复足踝部组织缺损12例[J].中华显微外科杂志,2014,37(4):387-388.
[8]尚博.跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系[J].实用临床医药杂志,2014,18(19):66-69.
[9]梁英杰,张光明,杨运发,等.腓肠神经营养血管逆行岛状皮瓣修复肢体远端皮肤缺损的临床应用[J].中国医学创新,2013,10(4):105-106.
[10]郑润泉,邹林,陈晨,等.邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效[J].骨科,2017,8(1):12-15.
[11]徐衍斌,初海坤,初海鹏,等.SandersⅣ型跟骨骨折治疗体会[J].中国医学创新,2012,9(11):37-39.
[12]朱学敏,唐三元,杨辉,等.跟骨骨折的微创治疗现状[J].生物骨科材料与临床研究,2014,11(1):31-34.
[13]赵旭,张连民.VSD封闭式负压引流在创伤性皮肤、软组织缺损中的应用及护理[J].中国医学创新,2012,9(17):156-157.
[14]罗长奇,方跃,屠重棋,等.闭合性跟骨骨折手术部位感染的危险因素分析[J].中华创伤骨科杂志,2016,18(12):1096-1099.
[15]雷林革,何如祥,王开栋,等.远端蒂腓肠神经营养血管皮瓣修复足踝及踝上组织缺损的临床应用[J].兰州大学学报(医学版),2014,40(1):45-49,53.
[16]肖海涛,李永林,钱汉根,等.穿支血管蒂皮瓣在臀区多部位难愈性创面修复中的应用[J].中华整形外科杂志,2009,25(1):11-13.
[17]杨国涛,李云龙,陈金亮,等.小腿旋转推进穿支皮瓣修复踝部创伤性溃疡18例[J].中华烧伤杂志,2015,31(6):464-465.
[18]潘敬舜,刘生和.改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用[J].创伤外科杂志,2016,18(4):214-216.
[19]康庆林,贾亚超,王亚洲,等.序贯式带蒂皮瓣修复足踝部皮肤缺损[J].中华显微外科杂志,2015,38(6):561-564.
[20]吴艳,吴明珑,吴丽,等.踝足部软组织缺损患者腓肠肌穿支皮瓣修复术后悬吊抬高的做法与体会[J].护理学报,2016,23(11):56-57.
[21]王海峰,朱捷,赵光勋,等.封闭负压引流结合穿支蒂皮神经营养血管皮瓣治疗足踝部创面[J].中国骨与关节损伤杂志,2014,29(12):1239-1241.
[22]段崇锋,焦涛,任孝燕,等.胫后动脉内踝上穿支蒂隐神经营养血管逆行岛状皮瓣修复足背及踝部软组织缺损[J].实用手外科杂志,2016,30(3):312-313,315.
[23]付记乐,高峻青,何斌,等.携带腓肠肌的胫后动脉穿支皮瓣修复足踝部腔隙性软组织缺损[J].中华显微外科杂志,2015,38(4):408-410.
[24]王道明,曾荣铭,余榕,等.皮瓣修复踝关节周围软组织缺损的疗效观察[J].实用手外科杂志,2016,30(3):309-311.