CAJ | 학술논문

目的探讨经皮双向半切跟腱延长治疗跟腱挛缩症的方法和临床疗效.方法 2006年5月至2011年11月,对59例跟腱挛缩症患者行经皮双向半切跟腱延长,其中男36例,女23例;平均年龄38.2岁;伴有足内翻42例,足外翻6例.手术分别于跟腱内外侧不同平面做两个约0.5cm纵行切口,经皮跟腱表面钝性分离,在跟腱内外侧分别切断跟腱,依据足内外翻畸形决定跟腱切断的平面,逐渐手法矫正背伸踝关节至30.,石膏托固定6周.术后随访跟腱的力量、踝背伸活动度;采用Hannover跟腱评分评分表进行功能评估.结果 52例患者获得随访,7例失访,随访时间6个月～5年,平均16.5个月.48例内外翻畸形均得到有效矫正,50例患足跟着地背伸踝关节时跟腱力量较健侧无明显差异,2例较患侧相对较弱.终末随访时所有病例踝关节背伸活动度从术前(2.8±0.3).增加至术后(28.5±1.4).,差异有统计学意义(P＜0.05).术后末次随访Hannover跟腱评分为(82.6±4.2)分,与术前(68.5±3.5)分比较,差异具有统计学意义(P＜0.05).优44例,良5例,可2例,差1例,优良率为94.2％.结论经皮双向半切延长术是治疗跟腱挛缩症的有效方法,创伤小,术后恢复快.
목적 탐토경피쌍향반절근건연장치료근건련축증적방법화림상료효.방법 2006년5월지2011년11월,대59례근건련축증환자행경피쌍향반절근건연장,기중남36례,녀23례;평균년령38.2세;반유족내번42례,족외번6례.수술분별우근건내외측불동평면주량개약0.5cm종행절구,경피근건표면둔성분리,재근건내외측분별절단근건,의거족내외번기형결정근건절단적평면,축점수법교정배신과관절지30.,석고탁고정6주.술후수방근건적역량、과배신활동도;채용Hannover근건평분평분표진행공능평고.결과 52례환자획득수방,7례실방,수방시간6개월～5년,평균16.5개월.48례내외번기형균득도유효교정,50례환족근착지배신과관절시근건역량교건측무명현차이,2례교환측상대교약.종말수방시소유병례과관절배신활동도종술전(2.8±0.3).증가지술후(28.5±1.4).,차이유통계학의의(P＜0.05).술후말차수방Hannover근건평분위(82.6±4.2)분,여술전(68.5±3.5)분비교,차이구유통계학의의(P＜0.05).우44례,량5례,가2례,차1례,우량솔위94.2％.결론 경피쌍향반절연장술시치료근건련축증적유효방법,창상소,술후회복쾌.
Objective To explore the surgical approach of percutaneous double hemisection and evaluate its clinical efficacies.Methods From May 2006 to November 2011,a total of 59 patients were recruited.There were 36 males and 21 females with a mean age of 38.2 years (range:8-62).Forty-two varus and 6 valgus feet underwent percutaneous double hemisection.The 0.5 cm coracoid incision was adopted at the medial and lateral aspects of Achilles tendon.Percutaneous double hemisection was employed according to the deformity angles of varus and valgus feet.Manipulative correction was applied slowly until 30°dorsiflexion of ankle.Short leg cast was immobilized for 5 weeks at 30°dorsiflexion of ankle.The force of Achilles tendon,motion of ankle and Hannover Achilles tendon scores were followed up.Results Fifty-two patients were followed up for a mean period of 16.5 months (range:6-60).Seven patients were lost.At the end of follow-up,48 patients with varus and valgus deformities were corrected effectively.When compared with the normal side,the force of Achilles of the operated side of 50 patients had no change while that of 2 patients decreased slightly; the motion of ankle joint increased from (2.8 ± 0.3) ° preoperatively to (28.5 ± 1.4) °postoperatively (P ＜ 0.05) ; the Hannover Achilles Tendon Scores rose from (68.5-± 3.5)preoperatively to (82.6 ± 4.2) points postoperatively (P ＜ 0.05).The outcomes were excellent (n =44),very good (n =5),good (n =2) and poor (n =1).The excellent and good rate was 94.2％.Conclusion As an effective therapy for Achilles tendon contracture syndrome,percutaneous double hemisection has fewer complications and a faster recovery.