| 杨衡,黄俊琪,王陶,等.改良腓肠肌腱瓣翻转联合抗生素骨水泥技术治疗跟腱术后再断裂感染.骨科,2022,13(4): 299-303. |
| 改良腓肠肌腱瓣翻转联合抗生素骨水泥技术治疗跟腱术后再断裂感染 |
| Modified Turndown Gastrocnemius Flap Combined with Antibiotic Bone Cement Beads and Vacuum-assisted Closure for Achilles Tendon Re-rupture with Infection |
| 投稿时间：2021-11-25 |
| DOI：10.3969/j.issn.1674-8573.2022.04.003 |
| 中文关键词: 跟腱断裂 骨水泥 腓肠肌腱瓣翻转 感染 手术并发症 负压封闭 |
| 英文关键词: Achilles tendon rupture Bone cement Turndown gastrocnemius flap Infection Surgical complication Vacuum-assisted closure |
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| 中文摘要: |
| 目的 探讨改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗跟腱术后再断裂合并感染的初期临床疗效。方法 回顾性分析2015年1月至2018年6月绵阳市中心医院与解放军中部战区总医院合作收治的17例跟腱再断裂合并感染病人，采用彻底清创，改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗，观察病人手术相关指标、术后并发症。记录病人术前及末次随访的美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足功能评分系统与疼痛视觉模拟量表（visual analogue scale，VAS）评分。采用踝关节功能Kofoed评分标准评价疗效。结果 17例病人均获得随访，随访时间为（12.8±4.4）个月（8~20个月）。16例病人术后切口获得一期愈合，1例术后伤口边缘皮肤浅表坏死，经过局部换药处理4周后伤口获得二期愈合。1例出现腓肠神经损伤，给予口服甲钴胺治疗后有所缓解。末次随访未观察到感染复发、再断裂、关节僵硬等严重并发症。AOFAS评分由术前（50.15±7.61）分改善至（90.12±5.46）分；VAS评分由术前（5.12±1.65）分减轻至（1.12±0.65）分，差异均有统计学意义（P＜0.05）。按踝关节Kofoed评分标准：优2例，良14例，及格1例。结论 对于跟腱术后再断裂合并感染的病人，采用改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗，初期临床疗效较好，是一种可行的选择方式。 |
| 英文摘要: |
| Objective To evaluate the preliminary clinical results of modified turndown gastrocnemius flap combined with antibiotic bone cement beads and vacuum-assisted closure in the treatment of Achilles tendon re-rupture with infection. Methods A total of 17 patients with Achilles tendon re-rupture with infection from January 2015 to June 2018 in Mianyang Central Hospital and General Hospital of Central Theater Command were treated by excessive debridement followed by modified turndown gastrocnemius flap combined with antibiotic bone cement beads and vacuum-assisted closure. The surgical related parameters and complications were observed. The American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score were recorded before and after the operation. The curative effect was evaluated by the Kofoed ankle scale. Results The follow-up time was (12.8±4.4) months (8-20 months). Primary healing was achieved in 16 patients, and in one patients with superficial necrosis of the wound edge, after 4 weeks of local dressing change, the wound achieved secondary healing. One case had sural nerve injury, which was relieved after oral Micobo tablets. At the last follow-up, no recurrent infection, re-rupture, or joint stiffness was observed. AOFAS scores were improved from preoperative (50.15±7.61) to 90.12±5.46 at the last follow-up. VAS scores were decreased from preoperative (5.12±1.65) to 1.12±0.65 at the last follow-up. There was significant difference (P＜0.05). According to the Kofoed ankle scale, curative effect was excellent in 2 cases, good in 14 cases and fair in 1 case. Conclusion Modified turndown gastrocnemius flap combined with antibiotic bone cement beads and vacuum-assisted closure could be suitable for Achilles tendon re-rupture with infection. |
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