摘要
目的探讨带血供的阔筋膜瓣修复伴止点撕脱的KuwadaⅢ~Ⅳ型跟腱断裂的临床疗效。方法病例系列报告。纳入2019年5月—2022年9月苏州瑞华骨科医院收治的KuwadaⅢ~Ⅳ型跟腱断裂伴止点撕脱患者8例,其中男6例、女2例,年龄30~56(43.2±3.8)岁,左足6例、右足2例,跟腱缺损长度4~8 cm。患者均采用带血供阔筋膜瓣修复跟腱缺损并重建跟腱止点。观察指标:(1)观察患者术中阔筋膜瓣穿支来源及吻合方式、阔筋膜渗血情况、手术时间、出血量、术后切口愈合情况及并发症。(2)术后1个月复查足踝部彩超,观察跟腱穿支血管血流情况;术后3个月复查足踝部MRI,评价阔筋膜瓣血供及跟腱愈合情况。(3)术后1、3、6个月采用美国足踝外科协会(AOFAS)踝后足评分评价踝关节活动度,采用膝关节运动(Tegner)评分评价运动水平,采用疼痛视觉模拟评分法(VAS)评价疼痛缓解情况,测量踝关节背伸、跖屈活动度评价足踝部功能恢复情况。对比术前和术后1、3、6个月上述指标。(4)术后3、6个月采用跟腱损伤疗效(Thermann)评分评价并对比疗效。结果(1)本组8例患者,阔筋膜穿瓣支血管来源于旋股外侧动脉斜支5例、旋股外侧动脉降支2例、旋股外侧动脉横支1例;阔筋膜瓣穿支血管与供区胫后动脉分支吻合5例、血流桥接吻合3例。8例患者均顺利完成手术,术毕阔筋膜瓣渗血良好,术中出血量20~30(25.2±3.5)mL,手术时间2.5~5.0(2.5±2.1)h。患者术后恢复良好,切口均一期愈合。术后住院期间无伤口感染、伤口出血、皮肤坏死等并发症发生。(2)8例患者均获随访,随访时间6~18(10.2±2.8)个月。术后1个月复查足部彩超显示,修复缺损跟腱的阔筋膜穿支血管血流通畅;术后3个月复查足踝部MRI显示修复缺损跟腱的阔筋膜信号与近端跟腱一致。随访期间患者均未出现跟腱再次断裂,无跟腱挛缩、瘢痕增生、患足肿胀等并发症发生。
Objective This work aims to investigate the clinical efficacy of vascularized fascia lata flap to repair Kuwada typeⅢ−ⅣAchilles tendon rupture with avulsion of the insertion point.Methods This was a cases series report.Eight patients with Kuwada typeⅢ−Ⅳachilles tendon rupture and insertion point avulsion admitted to Suzhou Ruihua Orthopedic Hospital from May 2019 to September 2022 were included in this work.Among them,six were males and two were females,aged 30−56(43.2±3.8)years.There were six cases in the left foot and two cases in the right foot,and the length of the Achilles tendon defect was 4−8 cm.All patients used vascularized fascia lata flap to repair Achilles tendon defects and reconstruct the Achilles tendon insertion point.Observation indicators:(1)we observed the source and anastomosis method of the fascia lata flap perforator during surgery,the condition of fascia lata blood leakage,surgical time,bleeding volume,postoperative incision healing,and complications of the patient.(2)Follow-up foot color via Doppler ultrasound was conducted 1 and 2 months after surgery to observe the blood flow of the Achilles tendon perforator vessel.Three months after surgery,the foot MRI was reviewed to evaluate the blood supply to the fascia lata flap and the healing of the Achilles tendon.(3)At 1,3,and 6 months after surgery,the American Association of Foot and Ankle Surgeons(AOFAS)Ankle Posterior Foot Scale was used to evaluate ankle joint range of motion,the Knee Joint Movement(Tigner)Scale was used to evaluate movement level,the Pain Visual Analog Scale(VAS)Scale was used to evaluate pain relief,and the ankle dorsiflexion and plantar flexion range of motion were measured to evaluate foot and ankle functional recovery.The above indicators were compared before and 1,3,and 6 months after surgery.(4)The Thermann score was used to evaluate and compare the efficacy of Achilles tendon injury at 3 and 6 months after surgery.Results(1)In this group of 8 patients,the perforating vessels of the fascia lata fl
作者
郭礼平
柳志锦
周荣
王健
杨亮
巨积辉
Guo Liping;Liu Zhijin;Zhou Rong;Wang Jian;Yang Liang;Ju Jihui(Department of Wound repair,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)
出处
《中华解剖与临床杂志》
2023年第12期799-805,共7页
Chinese Journal of Anatomy and Clinics
基金
苏州市重点学科(SZXK202127)
江苏省研究生科研与实践创新计划(SJCX20_1076)
苏州市民生科技项目关键技术应用研究(SS202092)
苏州市卫生科教临床重点病种诊疗技术专项(LCZX202026)。
关键词
跟腱
创伤和损伤
游离组织瓣
阔筋膜瓣
移植
自体
显微外科手术
Achilles tendon
Wounds and injuries
Free tissue flaps
Fascia lata flap
Transplantation,autologous
Microsurgery
