CAJ | 학술논문

目的介绍运用桥式交叉联合游离肌皮瓣和游离腓骨治疗临床常见的严重小腿复合组织缺损手术修复方法,评价其临床应用的可行性. 方法选择2008年5月-2012年5月收治的12例小腿胫骨缺损伴软组织缺损患者,胫骨缺损均超过8 cm(9～ 12 cm),软组织缺损面积17 cm×12cm～20cm×18 cm.用桥式交叉联合背阔肌肌皮瓣及游离腓骨Ⅰ期修复,肩胛下动静脉为血管蒂与健侧小腿胫后动静脉端端吻合,胸背动脉远端分支前锯肌支为蒂与腓骨瓣的腓动静脉吻合.术后外固定支架固定双侧小腿. 结果所有患者得到随访,随访时间13～32个月,平均21个月.参照Enneking系统,12例患者游离背阔肌、游离腓骨串联移植后肢体平均功能评分23分,肢体功能恢复77％. 结论桥式交叉联合背阔肌肌皮瓣及游离腓骨皮瓣解决了受区血管条件有限的问题,是重建小腿大面积复合缺损的有效方法之一.
목적 개소운용교식교차연합유리기피판화유리비골치료림상상견적엄중소퇴복합조직결손수술수복방법,평개기림상응용적가행성. 방법 선택2008년5월-2012년5월수치적12례소퇴경골결손반연조직결손환자,경골결손균초과8 cm(9～ 12 cm),연조직결손면적17 cm×12cm～20cm×18 cm.용교식교차연합배활기기피판급유리비골Ⅰ기수복,견갑하동정맥위혈관체여건측소퇴경후동정맥단단문합,흉배동맥원단분지전거기지위체여비골판적비동정맥문합.술후외고정지가고정쌍측소퇴. 결과 소유환자득도수방,수방시간13～32개월,평균21개월.삼조Enneking계통,12례환자유리배활기、유리비골천련이식후지체평균공능평분23분,지체공능회복77％. 결론 교식교차연합배활기기피판급유리비골피판해결료수구혈관조건유한적문제,시중건소퇴대면적복합결손적유효방법지일.
Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.