严重后足损伤后足重建临床探究.doc

严重后足损伤后足重建临床探究 　【摘要】 探讨严重后足损伤后，通过后足重建恢复后足外形及功能的方法和临床效果。［方法］对6例严重后足损伤，进行后足重建术。其中,男4例，女2例。受伤原因为高处坠落伤5例，车祸伤1例。6例均有距骨及跟骨粉碎性骨折，距下、距舟、跟骰关节不同程度的脱位，跟骨骨折Sanders分型均为Ⅳ型；4例伴有后足前、内侧或足底跖侧皮肤挫裂伤，2例为后足前、内侧皮肤挫裂伤，另2例为足底跖侧皮肤挫裂伤，其中1例为后足前、内侧皮肤撕脱伤伴皮肤坏死缺损，1例为足底跖侧皮肤挫裂伤伴皮肤坏死缺损骨外露，按Gustilo分型：Ⅱ型2例，Ⅲ型A度1例，Ⅲ型B度1例。［结果］2例无皮肤挫裂伤者手术切口Ⅰ期愈合；4例伴有皮肤挫裂伤中1例手术切口渗出、裂开，经换药于术后4周愈合，余3例手术切口均Ⅰ期愈合；4例伴有后足前、内侧或足底跖侧皮肤挫裂伤者清创后2例伤口Ⅰ期愈合，1例后足前、内侧皮肤撕脱伤伴皮肤坏死缺损、1例后足足底跖侧皮肤挫裂伤伴皮肤坏死缺损骨外露，经换药形成肉芽创面新鲜后游离植皮分别于术后6、10周逐渐愈合。依据美国足踝骨科协会的足部评分标准(AOFAS)评分评价术后功能6例中：评分最低68分，最高91分。优1例，良3例，可2例。［结论］严重后足损伤后，通过后足重建术，可以恢复后足的外形，最大限度的保留后足功能，是治疗严重后足损伤的有效方法。 【关键词】 严重后足损伤 后足重建术 功能 Abstract：［Objective］To discuss the value and methods of severe hindfoot reconstruction in the treatment of hindfoot injures.［Method］Six cases with severe hindfoot injures were treated with hindfoot reconstruction.Among them, 4 patients were males and 2 females. Five cases were fallen from high places and 1 case by traffic accident. All cases associated with talus and calcancus comminuted fractures of type Ⅳ according to Sanders classification and calcaneocuboid, talocalcaneal and talonaviculare joint disorders.Four cases were associated with anterior and medial or plantar skin laceration,2 of anterior and medial skin laceration and 2 of plantar skin laceration. Among them, 1 were of anterior and medial skin avulsion wound and skin necrosis defect.1 were of plantar skin laceration and skin necrosis and bone exposure.［Result］Two cases’ incisions without skin laceration were healed up. Among 4 cases incisions with skin laceration, 3 were primarily healed. One was Ⅱperiod healed. Two cases’ skin laceration were healed by 1st incisions and 2 skin defects were healed by skin transplantation in 6 and 10 weeks after operation. The postoperative functional evaluation by AOFAS revealed excellent result in 1 foot, good in 3, fair in 2.［Conclusion］Hindfoot reconstruction is an effective method for severe hindfoot injures with the advantages of resoring function and outer aspect hind