中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
12期
1325-1330
,共6页
王碧菠%徐向阳%刘津浩%朱渊
王碧菠%徐嚮暘%劉津浩%硃淵
왕벽파%서향양%류진호%주연
跟腱%腱转移术%治疗结果
跟腱%腱轉移術%治療結果
근건%건전이술%치료결과
Achilles Tendon%Tendon transfer%Treatment outcome
目的 总结跟腱再断裂的原因,探讨“V-Y”推进瓣及(足母)长屈肌腱(flexor hallucis longus,FHL)转位修复重建跟腱再断裂的适应证、疗效及其相关并发症.方法 2006年3月至2010年1月手术修复重建跟腱再断裂患者16例16足,男12例,女4例；年龄35～72岁,平均50.9岁.再断裂距初次手术时间为6～49周(平均21.8周),随访时间6～52个月(平均27.5个月).充分清除断端瘢痕及坏死组织4例断端缺损＜4 cm者采用腓肠肌腱膜“V-Y”推进瓣修补,12例断端缺损＞4cm者采用FHL转位修复重建.结合患者病史、康复方式及再次手术术中所见跟腱形态,分析其发生再断裂原因.观察术后局部外观及功能恢复情况,并采用美国足踝外科协会踝-后足评分(American Orthopaedic Foot&Ankle Society-ankle and hindfoot score,AOFAS-AH)及Leppilahti跟腱修复评分进行疗效评价.结果 跟腱再断裂的原因主要为手术切口感染、术后跟腱愈合不良发生液化坏死、术后过早负重或活动不当致跌倒.采用“V-Y”推进瓣或FHL转位修复跟腱再断裂术后局部外观及功能恢复良好,AOFAS-AH评分从术前(70.2±8.5)分提高到(92.4±6.1)分；Leppilahti跟腱修复评分从术前(74.8±6.2)分提高到(91.7±4.8)分.踝部MRI显示跟腱部信号均匀,无撕裂或积液表现.结论 跟腱再断裂后需彻底清创,导致大范围缺损.腓肠肌腱膜“V-Y”推进瓣可修复＜4cm的缺损,FHL转位可修复重建＞4 cm的缺损,术后踝足部功能外形恢复良好.
目的 總結跟腱再斷裂的原因,探討“V-Y”推進瓣及(足母)長屈肌腱(flexor hallucis longus,FHL)轉位脩複重建跟腱再斷裂的適應證、療效及其相關併髮癥.方法 2006年3月至2010年1月手術脩複重建跟腱再斷裂患者16例16足,男12例,女4例；年齡35～72歲,平均50.9歲.再斷裂距初次手術時間為6～49週(平均21.8週),隨訪時間6～52箇月(平均27.5箇月).充分清除斷耑瘢痕及壞死組織4例斷耑缺損＜4 cm者採用腓腸肌腱膜“V-Y”推進瓣脩補,12例斷耑缺損＞4cm者採用FHL轉位脩複重建.結閤患者病史、康複方式及再次手術術中所見跟腱形態,分析其髮生再斷裂原因.觀察術後跼部外觀及功能恢複情況,併採用美國足踝外科協會踝-後足評分(American Orthopaedic Foot&Ankle Society-ankle and hindfoot score,AOFAS-AH)及Leppilahti跟腱脩複評分進行療效評價.結果 跟腱再斷裂的原因主要為手術切口感染、術後跟腱愈閤不良髮生液化壞死、術後過早負重或活動不噹緻跌倒.採用“V-Y”推進瓣或FHL轉位脩複跟腱再斷裂術後跼部外觀及功能恢複良好,AOFAS-AH評分從術前(70.2±8.5)分提高到(92.4±6.1)分；Leppilahti跟腱脩複評分從術前(74.8±6.2)分提高到(91.7±4.8)分.踝部MRI顯示跟腱部信號均勻,無撕裂或積液錶現.結論 跟腱再斷裂後需徹底清創,導緻大範圍缺損.腓腸肌腱膜“V-Y”推進瓣可脩複＜4cm的缺損,FHL轉位可脩複重建＞4 cm的缺損,術後踝足部功能外形恢複良好.
목적 총결근건재단렬적원인,탐토“V-Y”추진판급(족모)장굴기건(flexor hallucis longus,FHL)전위수복중건근건재단렬적괄응증、료효급기상관병발증.방법 2006년3월지2010년1월수술수복중건근건재단렬환자16례16족,남12례,녀4례；년령35～72세,평균50.9세.재단렬거초차수술시간위6～49주(평균21.8주),수방시간6～52개월(평균27.5개월).충분청제단단반흔급배사조직4례단단결손＜4 cm자채용비장기건막“V-Y”추진판수보,12례단단결손＞4cm자채용FHL전위수복중건.결합환자병사、강복방식급재차수술술중소견근건형태,분석기발생재단렬원인.관찰술후국부외관급공능회복정황,병채용미국족과외과협회과-후족평분(American Orthopaedic Foot&Ankle Society-ankle and hindfoot score,AOFAS-AH)급Leppilahti근건수복평분진행료효평개.결과 근건재단렬적원인주요위수술절구감염、술후근건유합불량발생액화배사、술후과조부중혹활동불당치질도.채용“V-Y”추진판혹FHL전위수복근건재단렬술후국부외관급공능회복량호,AOFAS-AH평분종술전(70.2±8.5)분제고도(92.4±6.1)분；Leppilahti근건수복평분종술전(74.8±6.2)분제고도(91.7±4.8)분.과부MRI현시근건부신호균균,무시렬혹적액표현.결론 근건재단렬후수철저청창,도치대범위결손.비장기건막“V-Y”추진판가수복＜4cm적결손,FHL전위가수복중건＞4 cm적결손,술후과족부공능외형회복량호.
Objective Recurrent rupture of Achilles tendon is a severe complication after primary repair.The optimal treatment remains controversial.This study was in aiming to explore the risk factors of recurrent ruptures of Achilles tendon,to evaluate the indication,outcome and complications of reconstructing Achilles tendon recurrent ruptures by V-Y advancement flap and Flexor Hallucis Longus tendon (FHL) transfer.Methods We retrospectively studied 16 cases who underwent reconstruction of Achilles tendon recurrent ruptures from Mar,2006 to Jan,2010.Among them there were 12 males and 4 females with the mean age of 50.9 years (35-72 years).The period of time between recurrent rupture and primary operation was 6-49 weeks(ave.21.8 weeks).The follow-up interval was 6-52 months (ave.27.5 months).During operatin,4 cases with a rupture gap less than 4 cm had received V-Y advancement flap and 12 cases with a rupture gap more than 4 cm had received FHL transfer.At the time of follow-up,all patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Leppilahti Achilles Tendon Repair score.Results The average AOFAS score had increased from 70.2±8.5 preoperatively to 92.4±6.1postoperatvely.Leppilahti Achilles Tendon Repair score had increased from 74.8±6.2 preoperatively to 91.7±4.8 postoperatvely.MRI of Achilles tendon showed even signal without signs of tear.Conclusion V-Y advancement flap could repair a rupture gap within 4 cm,FHL transfer is suitable for rupture gap over 4 cm in reconstruction of Achilles tendon recurrent ruptures.
