腓骨头复合皮瓣修复桡腕关节骨皮肤缺损

Fibular head composite flap in repairing the bone and skin defect of radiocarpal joint

目的探讨腓骨头复合皮瓣修复桡腕关节骨、皮肤缺损的临床效果。方法2009年8月至2016年12月，应用腓骨头复合皮瓣修复桡腕关节骨、皮肤缺损9例，患者均存在骨质缺损且伤及关节面，皮肤缺损面积为（3～7） cm×（5～10） cm。依照腓骨头部分的解剖学特征，以膝下外侧血管束为血管蒂并作为中心，按照腕部皮肤缺损创面的大小和形状，设计包含腓骨头的复合皮瓣。切取复合皮瓣对创面进行修复，皮瓣面积：（4～8） cm×（6～11） cm。术后采用Gartland-Werley腕关节功能评价系统评价。结果对9例患者进行随访0.5～3年，平均1.5年。供、受区切口均一期愈合，无感染，移植腓骨全部骨性愈合。腕关节活动范围：背伸29°～41°，平均32.9°；掌屈18°～33°，平均24.5°；前臂旋前56°～83°，平均75°；前臂旋后40°～78°，平均65.4°，平均握力为对侧的78%。Mayo腕关节功能评分为58～91分，平均85分。Gartland-Werley腕关节功能评分：优3例，良5例，中1例；优良率88.9%。患者腕关节稳定性均较好，没有活动性疼痛，恢复日常生活、工作能力。结论腓骨头复合皮瓣可较好地修复桡腕关节骨皮肤缺损。

ObjectiveTo investigate the therapeutic effect of fibular head composite flap in repairing the bone and skin defect of radiocarpal joint.MethodsFrom Aug.2009 to Dec.2016, 9 cases with bone and skin defects at radiocarpal joint were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect size was （3-7） cm×（5-10） cm.The joint function was assessed by the Gartland-Werley standard score.ResultsAll 9 patients were followed up for 6 months to 3 years, with an average of 18 months.Primary wound healing was achieved in all cases without infection.Bony union of the transplanted fibular head was observed .The range of motion （ROM） of the wrist joint and forearm was assessed as following： the mean extension range of motion was 32.9° （range 29°-41°）, flexion 24.5° （range 18°-33°）, pronation 75° （range 56°-83°）and supination 65.4° （range 40°-78°）. The average grip strength was 78% of that on the healthy side. Mayo wrist score was 85 on average, ranging from 58 to 91.By the Gartland-Werley standard score, the wrist function was rated as excellent in 3 case, good in 5 cases and fair in 1 case, with an excellent to good rate of 88.9%.All patients could cope with daily life and work, with good wrist stability and no motion-related pain.ConclusionsThe fibular head composite tissue flap has a good therapeutic effect in repairing the bone and skin defect of radiocarpal joint.