摘要
目的探讨儿童足后跟轮辐伤的致伤特点、分型、临床治疗方法及疗效。方法2001年6月-2008年6月,收治289例儿童自行车或摩托车所致足后跟轮辐伤。男179例,女110例;年龄2～12岁,平均3.9岁。根据自定标准将软组织损伤程度分为Ⅰ、Ⅱ、Ⅲ型:Ⅰ型皮肤挫裂伤179例,Ⅱ型皮肤、软组织缺损合并跟腱外露83例,Ⅲ型皮肤、软组织广泛缺损合并跟腱断裂、缺损27例。Ⅱ、Ⅲ型皮肤或软组织缺损范围3cm×2cm～11cm×7cm。受伤至入院时间1～53d,平均14.5d。Ⅰ型患儿彻底清创后包扎或缝合。Ⅱ型患儿采用局部筋膜蒂皮瓣53例、逆行腓肠神经营养血管皮瓣19例、逆行隐神经营养血管皮瓣9例、外踝上皮瓣2例修复创面。Ⅲ型患儿6例一期修复跟腱后逆行腓肠神经营养血管皮瓣移位修复;3例一期逆行腓肠神经营养血管皮瓣移位修复创面,二期行跟腱翻转筋膜条重建或同侧髂胫束移植;18例一期复合腓肠肌皮瓣推进修复创面及跟腱。皮瓣切取范围4cm×2cm～30cm×12cm。供区部分缝合后植皮修复。术后均行石膏固定。结果术后3d1例Ⅱ型患儿出现皮瓣远端静脉危象,术后3～5d6例Ⅲ型患儿出现皮瓣远端坏死,均经对症处理后成活;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。患儿均获随访,随访时间15～820d,平均42d。Ⅰ、Ⅱ型患儿足踝功能完全恢复;Ⅲ型25例术后3个月出现患侧踝关节背伸丢失(10～30°)及单侧提踵力量减弱,但不影响行走,余2例功能恢复良好。结论儿童足后跟轮辐伤受伤机制独特,临床应根据其分型进行相应处理。
Objective To evaluate the characteristics,classifi cation,treatment methods,and clinical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008,289 children with bicycle or motorcycle spoke heel injuries were treated,including 179 males and 110 females aged 2-12 years old （average 3.9 years old）. There were 179 cases of skin contusion and laceration （type I）,83 cases of skin and soft tissue defect with Achilles tendon exposure （type Ⅱ）,and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture （type Ⅲ）. The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type Ⅱ and type Ⅲ injury. The time between injury and hospital admission was 1-53 days （average 14.5 days）. Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type Ⅱ injury,the wound was repaired with the regional fascia flap in 53 cases,the reverse sural neurocutaneous vascular flap in 19 cases,the reverse saphenous neurocutaneous vascular flap in 9 cases,and the lateral supramalleolar flap in 2 cases. For the child patients with type Ⅲ injury,6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap,3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral iliotibial tract transplant,and 18 cases underwent primary repair of the wound and the Achilles tendon with the sliding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed by partial suture and split-thickness skins graft. The lower limbs were immobilized with plaster splints after operation. Results All the flaps survived except for 1 case of type Ⅱ suffering from distal flap venous crisis 3 days after o
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第10期1180-1182,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
足后跟
轮辐伤
分型
临床治疗
儿童
Heel Spoke injury Classifi cation Clinical treatment Children
