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目的总结儿童足后跟Ⅲ级轮辐伤的特点及治疗方法及疗效。方法回顾分析2007年1月-2013年6月收治的31例足后跟Ⅲ级轮辐伤患儿临床资料。男19例,女12例;年龄3~12岁,平均5.2岁。受伤至入院时间为2 h~26 d,平均4.4 d。足后跟皮肤软组织缺损范围3.5 cm×2.5 cm~8.0 cm×4.5 cm;伴跟腱缺损和跟骨结节骨缺损。16例跟腱缺损较大,不能直接拉伸至跟骨结节者,行复合腓肠肌皮瓣V-Y推进联合跟腱止点重建术,皮瓣切取范围为16 cm×5 cm~21 cm×10 cm。15例跟腱能拉伸至跟骨结节者,行局部带蒂皮瓣逆行移位修复联合跟腱止点重建术;皮瓣切取范围为4.0 cm×2.5 cm~8.0 cm×4.5 cm,均未行神经吻合术;皮瓣供区行刃厚皮片植皮修复。结果术后患儿均获随访,随访时间6个月~4年,平均13个月。除3例皮瓣发生远端部分坏死外,其余皮瓣均顺利成活,创面Ⅰ期愈合。皮瓣色泽、外形均良好,不影响穿鞋及行走,并恢复感觉。术后随时间延长,踝关节背伸角度逐渐改善,恢复单腿提踵站立。X线片示跟骨缺损部位骨质增长缓慢。结论儿童足后跟Ⅲ级轮辐伤有其自身特点,应根据跟腱和软组织缺损情况采取不同的手术方法。术后早期踝关节背伸功能明显受限,随时间延长,关节功能逐渐改善,但跟骨结节骨缺损需要长期随访。
Objective To summarize the characteristics, treatment and curative effect of grade Ⅲ heel injury in children’s heel. Methods The clinical data of 31 cases of heel Ⅲ heel wounded children who were treated from January 2007 to June 2013 were retrospectively analyzed. 19 males and 12 females; aged 3 to 12 years, mean 5.2 years old. Injury to admission time for 2 h ~ 26 d, an average of 4.4 d. The heel soft tissue defects of the heel ranged from 3.5 cm × 2.5 cm to 8.0 cm × 4.5 cm, with defects of the Achilles tendons and defects of the calcaneus nodules. 16 cases of Achilles tendon defect, can not be directly stretched to the calcaneal tubercle, the composite gastrocnemius flap VY promote joint Achilles tendon point reconstruction, skin flap range of 16 cm × 5 cm ~ 21 cm × 10 cm . 15 cases of Achilles tendon can be stretched to the calcaneal tubercle line partial pedicle flap retrograde shift repair combined with Achilles tendon only reconstruction; skin flap range of 4.0 cm × 2.5 cm to 8.0 cm × 4.5 cm, were No nerve anastomosis; skin flap for skin grafting skin repair. Results All patients were followed up for 6 months to 4 years with an average of 13 months. Except for 3 cases of distal flap necrosis, the remaining flaps survived successfully and the wound healed in the first stage. Flap color, shape are good, does not affect the shoes and walking, and restore the feeling. With the extension of time after surgery, ankle dorsiflexion angle gradually improved, to restore one leg raise heel stand. X-ray showed calcaneal defect site slow bone growth. Conclusion The heel Ⅲ heel injury has its own characteristics, should be based on Achilles tendon and soft tissue defect to take different surgical methods. Postoperative ankle dorsiflexion function was significantly limited, with time, joint function gradually improved, but the calcaneus bone defects need long-term follow-up.