一例幼年烧伤后严重足畸形的手术牵引治疗

A case of a serious foot deformity after burn surgery traction treatment

目的:探讨烧伤后严重足畸形修复的新术式。方法:在全麻下行足踝部瘢痕松解,同时手法牵引尽可能使畸形足复位,术中在小腿中远段、跟骨及跖骨留置克氏针,用克氏针做支点及橡皮筋作动力将足跟及跖骨向正常位置牵引,遗留创面植皮修复。术后11d首次更换敷料,术后25d,在术中留置的克氏针基础上制作牵引架,将各足趾及跖骨头向拉长、跖屈、内旋方向牵引;将跟骨向内旋、拉长方向牵引。术后78d,拆除牵引架出院,夜间应用石膏托固定踝关节于90°位,白天逐渐下地负重。结果:瘢痕松解植皮术后260d、牵引架拆除术后182d随访,患者右足外形、功能较术前明显改善,手术植皮区轻度回缩,步行时及步行后右足踝无酸困、疼痛。CT片显示:右足踝各关节基本复位,骨骼体积及骨密度较术前改善。结论:手术松解植皮联合骨牵引是矫治烧伤后严重足畸形的有效方法,创伤小、畸形不容易复发。

Objective To explore the new operation for severe foot deformity after burn repair.Methods In general anesthesia downlink foot scar solution, at the same time traction as far as possible to reset the clubfoot, intraoperative in calf cosco, heel bone and metatarsal lien＇s needle, needle was used to do pivot and the rubber band power to pull the heel and metatarsus to normal position, legacy skin graft to repair of the wound. First change dressings, 11 days after 25 days, after the needle was retained in operation on the basis of making drawing frame, each digit and broken metatarsal bones to spin, plantar lfexion, internal rotation direction traction. The calcaneal traction in the direction of spin, 78 days postoperatively, demolition of pulling out of the hospital, night cast ifxed ankle is applied to 90°, gradually down load during the day.Results260 days after skin grafting, traction demolition of postoperative follow-up of 182 days, compared with preoperative patients with right foot shape, function, skin graft surgery area mild retraction, walking and walking right ankle after acid trapped, pain.CT shows： the right ankle basic reset each joint, bone volume and bone mineral density compared with preoperative improvement.Conclusion Surgical release joint bone traction skin graft is an effective method to correct burn after severe foot deformity, trauma small, deformity is not easy to relapse.