首页|修复足踝部的带蒂皮瓣坏死分级系统的建立与初步验证

修复足踝部的带蒂皮瓣坏死分级系统的建立与初步验证

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目的 建立修复足踝部的带蒂皮瓣坏死分级系统，并初步验证其有效性和重复性。 方法 采用回顾性观察研究方法。以2010年1月至2022年1月期间，中国人民解放军联勤保障部队第九二〇医院骨科同一手术组完成的修复足踝部的带蒂皮瓣手术为基础，2位高年资医师选择40个病历资料完整的皮瓣坏死病例。由工作小组提出皮瓣坏死分级系统，并对40个病例进行分级。通过病例分级与治疗方法进行相关性研究，计算符合率，评价分级系统的有效性。40个病例中，每个病例选择1张典型术后坏死图片，请院外5位医生根据分级系统对图片进行分级；并将分级结果和标准分级进行加权Kappa分析，评价评分系统的重复性。计量资料以均值±标准差（Mean±SD）表示，符合率以百分率表示。 结果 本研究40个病例中，Ⅰ级7例，Ⅱ级16例，Ⅲ级12例，Ⅳ级5例。分级与实际治疗方法比较，总符合率92。5%，说明分级系统能有效指导治疗。5位医生分级的平均加权Kappa系数为0。628，95%置信区间（95%CI）为0。460~0。796，与标准分级有较强的一致性。 结论 本研究提出的修复足踝部的带蒂皮瓣坏死分级系统简单明了；经初步验证，分级系统能有效指导皮瓣坏死的治疗，且有较强的重复性。 Objective To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle， and to verify its effectiveness and repeatability。 Methods A retrospective observational study was conducted。 A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery， the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022。 A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded。 The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment。 One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps。 Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system。 Moreover， weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use， to evaluate the repeatability of the proposed grading system。 Evaluated data were expressed by Mean±SD， and the coincidence rate was expressed by percentage。 The reproducibility was studied by weighted Kappa analysis。 Results Of the 40 necrotic flaps， 7 flaps were classified in Grade I， 16 in Grade Ⅱ， 12 in Grade Ⅲ and 5 in Grade IV。 In comparison with the actual treatment methods， the overall coincidence rate of the grading system was 92。5%。 It indicated that the proposed grading system could effectively guide the selection of a treatment procedure。 The average weighted Kappa coefficient of surgeons was at 0。628 with a 95% confidence interval (95%CI) between 0。460-0。796， which was strongly consistent with the standard of the grading system currently in use。 Conclusion The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear。 It is able to effectively guide the treatment of flap necrosis。 The preliminary validation shows that the classification system has good repeatability。
Development and validation of a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle
Objective To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle, and to verify its effectiveness and repeatability. Methods A retrospective observational study was conducted. A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery, the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022. A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded. The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment. One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps. Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system. Moreover, weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use, to evaluate the repeatability of the proposed grading system. Evaluated data were expressed by Mean±SD, and the coincidence rate was expressed by percentage. The reproducibility was studied by weighted Kappa analysis. Results Of the 40 necrotic flaps, 7 flaps were classified in Grade I, 16 in Grade Ⅱ, 12 in Grade Ⅲ and 5 in Grade IV. In comparison with the actual treatment methods, the overall coincidence rate of the grading system was 92.5%. It indicated that the proposed grading system could effectively guide the selection of a treatment procedure. The average weighted Kappa coefficient of surgeons was at 0.628 with a 95% confidence interval (95%CI) between 0.460-0.796, which was strongly consistent with the standard of the grading system currently in use. Conclusion The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear. It is able to effectively guide the treatment of flap necrosis. The preliminary validation shows that the classification system has good repeatability.

FootAnklePedicled flapClassificationNecrosisComplication

何晓清、石岩、段家章、杨曦、董凯旋、张旭林、高定、杨杜明、苏踊跃、徐永清

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中国人民解放军联勤保障部队第九二〇医院骨科，昆明　650032

云南大学附属医院急诊外科，昆明　650021

云南省第一人民医院骨科，昆明　650032

遂宁市中心医院骨科，四川　遂宁　629000

梅州市人民医院骨科，广东　梅州　514000

大理市人民医院整形科，云南　大理　671000

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足 踝 带蒂皮瓣 分级 坏死 并发症

云南省创伤骨科临床医学中心昆明医科大学应用基础研究联合专项昆明医科大学应用基础研究联合专项昆明医科大学应用基础研究联合专项联勤保障部队第九二〇医院院内科技计划项目联勤保障部队第九二〇医院院内科技计划项目联勤保障部队第九二〇医院院内科技计划项目云南省骨科与运动康复临床医学研究中心

ZX20191001202101AY070001-298202201AY070001-288202201AY70001-2922019YGB052020YGD082020YGC02202102AA310068

2024

10.3760/cma.j.cn441206-20231011-00053

中华显微外科杂志
中华医学会

中华显微外科杂志

北大核心
影响因子：2.321
ISSN：1001-2036
年,卷(期)：2024.47(1)
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