CAJ | 학술논문

目的：介绍及评价腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的手术方法及术后疗效。方法回顾性研究2006年7月至2013年7月期间，本组采用腓肠肌前方腱膜松解治疗非痉挛性腓肠肌挛缩的患者。患者术前体检Silfverski?ld试验（＋），采用Baumann入路在腓肠肌与比目鱼肌间隙之间，松解腓肠肌前方腱膜，背伸踝关节至角度满意。术前和末次随访时测量踝关节的最大被动背伸角度（膝关节伸直位和屈曲90°时），进行美国足踝医师协会后足-踝关节（AOFAS-AH）评分，并记录术后并发症情况。结果29例（35足）患者获得随访，平均年龄36.5岁（8～69岁），平均随访32.6个月（7～54个月）。其中成人扁平足11例13足，儿童扁平足4例5足，踇外翻6例8足，跖筋膜炎5例6足，创伤性马蹄足3例3足。术前和末次随访时伸膝位踝关节最大被动背伸角度分别为（-5.7°±3.2°）（-15°～3°）和（8.2°±3.7°）（-6°～17°）（P＜0.01），背伸角度平均增加13.9°。 AOFAS-AH评分由术前平均46．7分提高到末次随访的75.1分（P＜0.01）。术后马蹄足畸形复发2例（2足），无过度延长、神经血管损伤及伤口并发症发生。结论腓肠肌前方腱膜松解操作方便，术后踝关节背伸角度恢复满意，跖屈肌力良好，未见明显并发症，是治疗非痉挛性腓肠肌挛缩安全、有效的手术方法。
목적：개소급평개비장기전방건막송해치료비경련성비장기련축적수술방법급술후료효。방법회고성연구2006년7월지2013년7월기간，본조채용비장기전방건막송해치료비경련성비장기련축적환자。환자술전체검Silfverski?ld시험（＋），채용Baumann입로재비장기여비목어기간극지간，송해비장기전방건막，배신과관절지각도만의。술전화말차수방시측량과관절적최대피동배신각도（슬관절신직위화굴곡90°시），진행미국족과의사협회후족-과관절（AOFAS-AH）평분，병기록술후병발증정황。결과29례（35족）환자획득수방，평균년령36.5세（8～69세），평균수방32.6개월（7～54개월）。기중성인편평족11례13족，인동편평족4례5족，무외번6례8족，척근막염5례6족，창상성마제족3례3족。술전화말차수방시신슬위과관절최대피동배신각도분별위（-5.7°±3.2°）（-15°～3°）화（8.2°±3.7°）（-6°～17°）（P＜0.01），배신각도평균증가13.9°。 AOFAS-AH평분유술전평균46．7분제고도말차수방적75.1분（P＜0.01）。술후마제족기형복발2례（2족），무과도연장、신경혈관손상급상구병발증발생。결론비장기전방건막송해조작방편，술후과관절배신각도회복만의，척굴기력량호，미견명현병발증，시치료비경련성비장기련축안전、유효적수술방법。
Objective To investigate the surgical method and the clinical results of the anterior aponeurotic recession of gastrocnemius for non-spastic gastrocnemius contraction .Methods The patients with non-spastic gastrocnemius contraction treated by the anterior aponeurotic recession of gastrocnemius during July 2007 to July 2013, were retrospectively studied .All the patients were preoperatively identified by Silfverskiold test , and received the anterior aponeurotic recession of gastrocnemius in the interval between the gastrocnemius and soleus muscle bellies ( Baumann approach ) .The preoperative and follow-up evaluations included the maximal angle of dorsiflexion in the ankle while the knee fully extended and flexed to 90 degrees, AOFAS ankle hindfoot score and the postoperative complications .Results 29 patients (35 feet) were followed up for 32.6 months (range, 7 to 54 months), including adult flatfoot (11 cases, 13 feet), children flatfoot (four cases, five feet), hallux valgus (six cases, eight feet), plantar fasciitis (five cases, six feet) and traumatic equines (three cases, three feet).The maximal angle of dorsiflexion in the ankle when the knee extended improved from ( -5.7 ±3.2 ) degrees ( range, -15 to 3 degrees ) preoperatively to (8.2 ±3.7) degrees (range, -6 to 17 degrees) at the last follow-up (P<0.01), with a net improvement of 13.9 degrees.The AOFAS score also improved from 46.7 to 75.1 (P<0.01).Two patients ( two feet ) had a recurrence of equinus , and there was no complication of overcorrection , neurovascular injury or healing problems .Conclusion The anterior aponeurotic recession of gastrocnemius is an effective and safe procedure to correct gastrocnemius contraction , without severe postoperative complications .