低旋转点和传统腓肠神经营养血管皮瓣修复足背、足跟软组织缺损的比较研究

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　　 【摘要】 目的：探析低旋转点和传统腓肠神经营养血管皮瓣修复足背、足跟软组织缺损的效果。方法：选取2016年1月-2018年7月本院接收的76例小腿下足背、足跟软组织缺损患者，按照随机数字表法将患者分为研究组和对照组，每组38例。研究组采用低旋转点腓肠神经营养血管皮瓣，旋转点以外踝尖上1～3 cm位置为主;对照组为传统腓肠神经营养血管皮瓣，旋转点在外踝尖上5～7 cm位置，对比两组治疗效果、并发症发生率、伤口恢复正常和生理功能恢复正常时间。结果：研究组治疗总有效率高于对照组，并发症发生率低于对照组，伤口恢复正常时间和生理功能恢复正常时间均短于对照组，差异均有统计学意义（P<0.05）。结论：采取低旋转点腓肠神经营养血管皮瓣修复方法可有效修复足背中远部、前足和足跟的软组织缺损，使创面早期愈合，减少并发症的发生。
　　 【关键词】 足背、足跟软组织缺损; 低旋转点; 传统腓肠神经营养血管; 皮瓣
　　 【Abstract】 Objective：To investigate the effects of low rotation point and traditional sural neurovascular flap in repairing soft tissue defects of the back and heel.Method：From January 2016 to July 2018，76 patients with soft tissue defect of lower leg dorsum and heel were selected and divided into study group and control group according to random number table method，38 cases in each group.In the study group，the low rotation point skin flap was used，and the rotation point was 1-3 cm above the lateral ankle tip.In the control group，the traditional sural neurovascular flap was used，and the rotation point was 5-7 cm above the lateral ankle tip.The therapeutic effect，complication rate，wound recovery and physiological function recovery time were compared between the two groups.Result：The total effective rate of the study group was higher than that of the control group，the incidence of complication of the study group was lower than that of the control group，the time of wound and the time of physiological function returned to normal were shorter than those in the control group，the differences were statistical significance（P<0.05）.Conclusion：The low rotation point sural neurovascular flap repair can effectively repair the middle and distal soft tissue defects in the dorsum of the foot，the forefoot and the heel，it makes the wound can heal early and reduce complications.
　　 【Key words】 Soft tissue defect in dorsum and heel of the foot; Low rotation point; Traditional gastrocnemius vascular; Flap
　　 First-author’s address：The People’s Hospital of Gaoxin District in Zhaoqing City，Zhaoqing 526238，China
　　 doi：10.3969/j.issn.1674-4985.2019.11.030
　　 臨床骨科中较为常见的一种疾病是踝关节、足背及足跟软组织缺损，其表面软组织覆盖相对较小、血运不理想、角质层相对较厚，软组织缺损后，延缓了肉芽组织生长速度，容易外露肌腱和骨腱，导致肌腱坏死及骨髓炎等症状[1]。与此同时，周围缺乏充足的可供转移的软组织，而采用远处转移的皮瓣，需要联合显微外科技术，且伴有较高的风险程度，增加了患者痛苦程度[2]。以往的腓肠神经营养血管皮瓣存在较高的转点，足背及足跟软组织缺损修复难度较大[3]。基于此，本研究主要针对小腿足背、足跟软组织缺损患者行低旋转点和传统腓肠神经营养血管皮瓣修复效果进行探析，现报道如下。
　　1 资料与方法
　　1.1 一般资料 选取2016年1月-2018年7月本院接收的小腿下足背、足跟软组织缺损患者76例为研究对象。纳入标准：足跟位置慢性溃疡性患者且小腿足背全部完好者;足跟位置肌腱和骨外露;排除标准：存在严重心理及精神疾病者;存在意识、认知障碍者;伴有心脏、肾、肝等严重器官功能不全者。按照随机数字表法将患者分为研究组和对照组，各38例。本研究经医院伦理委员会批准，患者均知情同意。
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