创伤负压治疗技术辅助逆行腓肠神经营养血管皮瓣修复足踝部创面效果观察

Negative pressure wound therapy combined with a retrograde sural neurovascular flap for repair of foot and ankle wounds

目的探讨创伤负压治疗技术(NPWT)辅助逆行腓肠神经营养血管皮瓣修复足踝部创面的效果。方法选取山东省文登整骨医院2019年7月至2020年1月收治的足踝部创面患者88例,采用随机数字表法分为对照组44例、观察组44例。对照组采用逆行腓肠神经营养血管皮瓣修复,观察组采用NPWT辅助逆行腓肠神经营养血管皮瓣修复,比较两组临床效果、皮瓣存活情况、创面愈合率、术后踝关节功能评分。结果观察组总有效率为97.73%(43/44),高于对照组的81.82%(36/44),差异有统计学意义(χ^(2)=6.07,P=0.014);观察组皮瓣存活率为100.00%(44/44),高于对照组的86.36%(38/44),差异有统计学意义(χ^(2)=4.47,P=0.034);观察组创面愈合率为97.73%(43/44),高于对照组的79.55%(35/44),差异有统计学意义(χ^(2)=7.22,P=0.007)。术后半年,观察组疼痛评分(1.81±0.45)分、步态评分(1.40±0.41)分、足踝部肿胀评分(1.98±0.38)分、距下关节活动范围评分(0.41±0.35)分、踝活动范围评分(0.84±0.51)分,均优于对照组(t=2.63、2.62、2.15、2.09、2.02,均P<0.05)。结论NPWT辅助逆行腓肠神经营养血管皮瓣修复足踝部创面,皮瓣存活率、创面愈合率较高,可显著改善患者踝关节功能。

Objective To investigate the efficacy of negative pressure wound therapy(NPWT)combined with a retrograde sural neurovascular flap for the repair of foot and ankle wounds.Methods Eighty-eight patients with foot and ankle wounds who received treatment in Shandong Wendeng Osteopathic Hospital from July 2019 to January 2020 were included in this study.They were randomly assigned to undergo either NPWT combined with retrograde sural neurovascular flap repair(observation group,n=44)or retrograde sural neurovascular flap repair alone(control group,n=44).Clinical efficacy,flap survival,wound healing,and postoperative ankle function scores were compared between the two groups.Results Total response rate was significantly higher in the observation group than in the control group[97.73%(43/44)vs.81.82%(36/44),χ^(2)=6.07,P=0.014].Flap survival rate was significantly higher in the observation group than in the control group[100.00%(44/44)vs.86.36%(38/44),χ^(2)=4.47,P=0.034].Wound healing rate was significantly higher in the observation group than in the control group[97.73%(43/44)vs.79.55%(35/44),χ^(2)=7.22,P=0.007].Half a year after surgery,pain score,gait score,foot and ankle swelling score,range of motion of the tibiotalar joint,range of motion of the ankle joint were(1.81±0.45)points,(1.40±0.41)points,(1.98±0.38)points,(0.41±0.35)points,and(0.84±0.51)points,respectively in the observation group,which were significantly lower than those in the control group(t=2.63,2.62,2.15,2.09,2.02,all P<0.05).Conclusion NPWT combined with a retrograde sural neurovascular flap greatly increases flap survival rate and wound healing rate and improves the ankle function of patients with foot and ankle wounds.