儿童内踝骨与皮肤缺损重建的中远期随访

Middle and long term follow-up for medial malleolus reconstruction and skin repair in children

目的探讨腓骨头复合组织瓣重建儿童内踝骨与皮肤缺损的中远期临床效果。方法对采用腓骨头复合组织瓣重建儿童内踝骨与皮肤缺损9例进行随访，随访时间3．5—8年，并对踝关节功能进行评价，对出现并发症的患者进行有效地治疗。结果所有患者均在校学习，能参加各项活动，双足发育未见明显差异；移植的腓骨头与内踝重建结合部均骨性愈合。随访期间未发生二次骨折；所有移植的腓骨头未出现骨骺闭合现象，移植腓骨头均出现同步生长现象。3例胫骨下端内侧骨骺出现不同程度的骨骺早闭，出现轻度的足内翻，对于较为严重的2例，1例行外侧骨骺阻滞术（9岁），1例行内侧植骨矫形术（14岁）。根据AOFAS中足评分标准对患足功能进行评定：优3例，良4例，可2例。结论腓骨头复合组织瓣是重建儿童内踝骨与皮肤缺损的一种较好方法，在发育过程中出现的并发症要及时治疗，可以达到良好的治疗效果。

Objective To investigate the middle and long term clinical effect of fibular head complex tissue flap to rebuild the bone and skin defect of medial mal]eolus in children. Methods Nine children with bone and skin defect of medial malleolus rebuilt by fibular head complex tissue flap were followed up,the follow-up time ranged from 3.5 years to 8 years. The ankle joint function was evaluated, and the complications were effectively treated. Results All the children studied at school and attended all kinds of activities. There were no difference between their both feet, fibular head transplanted combine together with medial malleolus, and repeated fracture do not happen in the time of follow-up visit. The epiphyseal arrest did not occur for transplanted fibular head which appeared synchronous growth. Different degree epiphyseal arrest was observed at the wall inferior extremity of tibia, and lower grade strephenopodia appeared in 3 children.The lateral epiphyseal arrest was performed on a 9 year old child and wall bone graft on a 14 year old child. Functional assessment according to the American Orthopaedic Foot ＆ Ankle Society （AOFAS） rated the results as excellent in 3 cases, good in 4 cases and common in 2 cases. Conclusion The fibular head complex tissue flap to rebuild the bone and skin injury of medial malleolus is a good way in children. The complications in development process are treated in time to achieve favorable clinical effect.