三种皮瓣修复开放性踝关节骨折脱位软组织缺损△

Three kinds of flaps for repairing soft tissue defect complicated with open ankle fracture disloca

摘要:

[目的] 比较三种皮瓣修复开放性踝关节骨折脱位软组织缺损的临床效果。[方法] 回顾性分析2015 年1 月—2021年2 月本科收治的开放性踝关节骨折脱位51 例患者的临床资料。根据医患沟通结果，29 例采用胫后动脉穿支螺旋桨皮瓣组（perforating artery perforator flap, PAPF），15 例采用腓动脉穿支-腓肠神经皮瓣组（sural neurocutaneous flap, SNCF），7 例采用股前外侧游离皮瓣（anterolateral thigh flaps, ALTF）。比较三组围手术期及随访结果。[结果] ALTF 组手术时间[(165.5±26.4) minvs (125.3±13.8) min vs (120.8±11.3) min, P＜0.001]、皮瓣面积[(62.7±6.7) cm2 vs (55.3±6.4) cm2 vs (54.9±8.2) cm2, P=0.038]、术中失血量[(298.6±30.7) ml vs (238.9±38.9) ml vs (229.6±30.7) ml, P＜0.001] 均显著大于PAPF 组和SNCF 组，PAPF 组和SNCF 组差异无统计学意义（P＞0.05）。三组患者与初次手术间隔时间、供区闭合形式、供区愈合情况、住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（14.7±2.0） 个月。三组完全负重活动时间的差异无统计学意义（P＞0.05）。术后随时间推移，三组VAS评分、踝背伸-跖屈ROM、AOFAS 评分、供区瘢痕评分均显著改善（P＜0.05），PAPF 组受区感觉功能分级显著改善（P＜0.05），而SNCF 组和ALTF 组无显著变化（P＞0.05）。末次随访，PAPF 组、SNCF 组的踝背伸-跖屈ROM 均显著优于ALTF 组[(62.1±5.1)° vs (61.7±6.2)° vs (54.9±5.3)°, P=0.010]，PAPF 组和ALTF 组的受区感觉功能分级[优/良/可/差: (17/7/3/2) vs (4/1/1/1) vs(2/3/7/3), P=0.046] 、供区瘢痕评分[(3.9±0.9) vs (4.2±1.3) vs (5.1±0.9), P＜0.001] 显著优于SNCF 组。[结论] PAPF 逆行皮瓣修复开放性踝关节骨折脱位术后皮肤缺损并发症少，皮瓣外观及感觉功能恢复满意度高。

Abstract:

[Objective] To compare the clinical outcomes of three kinds of flaps in repairing soft tissue defect complicated with openankle joint fracture and dislocation. [Methods] A retrospective study was conducted on 51 patients who received surgical treatment for softtissue defect complicated with open ankle fracture and dislocation in our department from January 2015 to February 2021. According todoctor-patient communication, 29 cases received perforating artery perforator flap (PAPF), 15 cases received sural neurocutaneous flap(SNCF), and 7 cased underwent anterolateral thigh flaps (ALTF). The documents of perioperative period and follow-up were comparedamong the three groups. [Results] The ALTF group proved significantly greater than the PAPF and SNCF in terms of operation time of[(165.5±26.4) min vs (125.3±13.8) min vs (120.8±11.3) min, P＜0.001], flap area [(62.7±6.7) cm2 vs (55.3±6.4) cm2 vs (54.9±8.2) cm2, P=0.038], intraoperative blood loss [(298.6±30.7) ml vs (238.9±38.9) ml vs (229.6±30.7) ml, P＜0.001], whereas there were no statistical signifi-cances between PAPF and SNCF groups in abovesaid items (P＞0.05). However, there were no significant differences among the threegroups in terms of the time interval of two stage operations, the closure form of donor area, the healing of donor area, and the hospital stay(P＞0.05). All the patients in the 3 groups were followed up for a mean of (14.7±2.0) months, and there was no significant difference in thetime to resume full weight-bearing activity among the three groups (P＞0.05). The VAS score, ankle dorsal-plantar flexion ROM, AOFASscore and donor scar score were significantly improved over time (P＜0.05). The PAPF group got significant improvement in sensory functionwith time (P＜0.05), while the SNCF group and ALTF group had it remained unchanged (P＞0.05). At the last follow-up, the ankle dorsalplantarflexion ROM in PAPF and SNCF groups was significantly better than that in ALTF group [(62.1±5.1)° vs (61.7±6.2)° vs (54.9±5.3)°,P=0.010]. The PAPF and ALTF group were significantly better than SNCF in terms of sensory function [excellent/good/fair/poor: (17/7/3/2)vs (4/1/1/1) vs (2/3/7/3), P=0.046], and the donor scar score [(3.9±0.9) vs (4.2±1.3) vs (5.1± 0.9), P＜0.001]. [Conclusion] PAPF retrogradeskin flap for the repairing soft tissue defect complicated with open ankle fracture and dislocation has advantages of few complications, moresatisfactory flap appearance and better sensory function recovery.