CAJ | 학술논문

目的探讨总结应用股前外侧肌皮瓣修复足踝侧方软组织合并内、外踝组织缺损中重建踝关节稳定性的疗效与作用.方法对13例因足踝侧方软组织合并内、外踝组织缺损伤病例应用股前外侧肌皮瓣修复,将组织瓣中的阔筋膜两侧部分折叠与受区相邻软组织间断缝合固定,旋股外侧血管降支与受区血管吻合,移植股前外侧肌皮瓣面积最大为20 cm×12 cm,术后3个月石膏继续固定维持踝关节于功能位.随访时间1.5至20年.从患者主观感受、临床症状与体征和影像学检查评估踝关节稳定情况.结果术后早期3个月内踝关节稳定性仍需外固定维持扶助,半年后即可稳定.13例中获得5年以上随访10例、10年以上6例、15年以上3例(分别为15年、18年、20年).5年后均有影像学踝关节创伤性改变,但临床症状与之不完全呈现相关性,13例中目前尚无1例因功能受限需行关节融合术.结论股前外侧肌皮瓣是修复足踝侧方软组织合并内、外踝组织缺损重建并维持踝骨关节稳定、避免早期关节融合,特别对青少年伤者是一种良好选择.
목적 탐토총결응용고전외측기피판수복족과측방연조직합병내、외과조직결손중중건과관절은정성적료효여작용.방법 대13례인족과측방연조직합병내、외과조직결손상병례응용고전외측기피판수복,장조직판중적활근막량측부분절첩여수구상린연조직간단봉합고정,선고외측혈관강지여수구혈관문합,이식고전외측기피판면적최대위20 cm×12 cm,술후3개월석고계속고정유지과관절우공능위.수방시간1.5지20년.종환자주관감수、림상증상여체정화영상학검사평고과관절은정정황.결과 술후조기3개월내과관절은정성잉수외고정유지부조,반년후즉가은정.13례중획득5년이상수방10례、10년이상6례、15년이상3례(분별위15년、18년、20년).5년후균유영상학과관절창상성개변,단림상증상여지불완전정현상관성,13례중목전상무1례인공능수한수행관절융합술.결론 고전외측기피판시수복족과측방연조직합병내、외과조직결손중건병유지과골관절은정、피면조기관절융합,특별대청소년상자시일충량호선택.
Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.