鸟嘴型跟骨骨折术后软组织坏死的显微外科修复八例

Microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture in 8 cases

目的探讨跟骨鸟嘴型骨折术后软组织坏死的显微外科修复的临床疗效。方法2012年1月至2017年3月,对8例跟骨鸟嘴型骨折术后软组织坏死的患者采用外科皮瓣一期修复创面,其中5例采用腓肠神经营养血管皮瓣一期修复,2例采用腓动脉穿支螺旋桨皮瓣修复,1例采用胫后动脉穿支螺旋桨皮瓣修复。3例皮瓣供区直接缝合,5例不能直接缝合患者采用中厚皮片游离植皮。皮瓣切取面积5.0 cm×3.0 cm^7.0 cm×5.0 cm。术后通过门诊复诊及微信随访,对患者皮瓣成活度、是否感染、皮瓣外形、感觉以及踝关节功能进行疗效评价。结果术后皮瓣及植皮完全成活。所有患者均获得随访,时间6~12个月,平均8.4个月,皮瓣成活良好,无软组织及跟骨感染等并发症,皮瓣质地良好,外形满意,踝关节功能恢复良好。末次随访按照英国医学研究院将感觉功能分成6级,3例感觉恢复为S2,余下5例为S1。根据美国矫形足踝协会的踝-后足量表评估,优5例,良3例。所有患者在最后一次随访时都具有良好的临床结果和满意度。结论对跟骨鸟嘴型骨折术后软组织坏死的治疗,采用显微外科皮瓣修复,能够一期覆盖创面,避免跟骨骨髓炎的发生,能早期康复锻炼,踝关节功能恢复良好。

Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture. Methods From January, 2012 to March, 2017, surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture. Five patients underwent sural neurovascular flap in the first stage of repair, 2 patients were treated with peroneal perforator propeller flap, and 1 patient was treated with posterior tibial artery perforator propeller flap. The donor sites of 3 flaps were directly closed, and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly. The size of flap was 5.0 cm × 3.0 cm-7.0 cm × 5.0 cm. Through postoperative outpatient and WeChat follow-up. The patient’s flap survival, infection, flap shape, sensation and ankle function were evaluated. Results All flaps and skin grafts survived post-operatively. All patients were followed-up for 6-12 (mean, 8.4) months. All patients had good flap survival and no complications such as soft tissue and calcaneal infection. The flaps were good in texture, shape and function of ankle. At the last follow-up, according to the British Medical Research Institute (BMRI), the sensory function was divided into 6 levels. The flap sensory function recovered to S2 in 3 cases, and the remaining 5 cases was S1. According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS), the results were excellent in 5 cases, and good in 3 cases. All patients had good clinical results and satisfaction at the last followed-up. Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps, which avoided the occurrence of calcaneal osteomyelitis. It is easy to perform early rehabilitation exercise and the ankle function is well restored.