CAJ | 학술논문

目的探讨以穿支血管为蒂胫后动脉穿支骨(膜)皮瓣游离移植修复手部复合组织缺损的方法及疗效.方法对9例外伤性手部骨、皮肤软组织缺损患者,术前行小腿部动脉数字减影血管造影,依据胫后动脉造影结果及解剖特点,选择以胫骨滋养动脉或胫后动脉发出的骨(膜)皮穿支血管为蒂,切取胫后动脉穿支胫骨骨(膜)皮瓣,游离移植修复手部骨和皮肤软组织缺损.骨瓣切取大小为1.5 c×0.6 cm×0.4cm～3.5cm×0.7cm×0.5 cm.皮瓣切取面积为4.0 cm×3.5 cm～7.0 cm×4.0 cm.结果术后9例复合组织瓣完全存活,随访时间为3～18个月,骨缺损植骨处骨折线于术后3～4个月消失,骨折全部愈合.按照中华医学会手外科学会上肢部分功能评定试用标准中总主动活动度(TAM)系统评定法进行关节功能评价,优良率为88.9%,效果满意.结论对于各种原因造成的手部复合组织缺损,采用胫后动脉穿支胫骨骨(膜)皮瓣游离移植修复,不牺牲主干血管,供区与受区血管管径相当,便于血管吻合,组织移植后对供区影响小,骨愈合时间短,是一种较理想的治疗方法.
목적 탐토이천지혈관위체경후동맥천지골(막)피판유리이식수복수부복합조직결손적방법급료효.방법 대9예외상성수부골、피부연조직결손환자,술전행소퇴부동맥수자감영혈관조영,의거경후동맥조영결과급해부특점,선택이경골자양동맥혹경후동맥발출적골(막)피천지혈관위체,절취경후동맥천지경골골(막)피판,유리이식수복수부골화피부연조직결손.골판절취대소위1.5 c×0.6 cm×0.4cm～3.5cm×0.7cm×0.5 cm.피판절취면적위4.0 cm×3.5 cm～7.0 cm×4.0 cm.결과 술후9례복합조직판완전존활,수방시간위3～18개월,골결손식골처골절선우술후3～4개월소실,골절전부유합.안조중화의학회수외과학회상지부분공능평정시용표준중총주동활동도(TAM)계통평정법진행관절공능평개,우량솔위88.9%,효과만의.결론 대우각충원인조성적수부복합조직결손,채용경후동맥천지경골골(막)피판유리이식수복,불희생주간혈관,공구여수구혈관관경상당,편우혈관문합,조직이식후대공구영향소,골유합시간단,시일충교이상적치료방법.
Objective To study the methods and effects of repairing composite tissue defects of the hand by transfering posterior tibial artery perforator bone(periosteum) flap.Methods Nine cases of traumatic bone and soft tissue defects in the hand underwent digital subtraction angiography (DSA) of the lower leg preoperatively.According to angiography results and the anatomical characteristics, the tibial nutrient artery or osteoseptocutaneous perforator vessel of the posterior tibial artery was selected as vascular pedicle to harvest tibial artery perforator bone (periosteum) flap.The osteocutaneous flap was transferrede to repair the bone and soft tissue defect in the hand.The volume of the harvested bone ranged from 1.5 cm× 0.6 cm× 0.4 cm to 3.5 cm×0.7 cm×0.5 cm.The area of the skin flap ranged from 4.0cm×3.5cm to 7.0cm×4.0cm.Results All the composite tissue flaps survived completely.Postoperative follow-up for 3 to 18 months revealed that the fracture line disappeared in 3 to 4 months and all fractures healed.According to the TAM system of joint function assessment/provisional upper limb function evaluation standard isled by the Chinese Hand Surgery Society,88.9% of the cases achieved satisfactory results.Conclusion Transfer of posterior tibial artery perforator bone (periosteum) flap is an ideal procedure to repair composite tissue defects of the hand.No major vessel of the donor site is sacrificed.The good size match between the vessels of the donor site and recipient site makes vascular anastomosis easy.Donor site morbidity is minor.Bone healing time is short.