CAJ | 학술논문

背景：足踝部创伤可导致患者较长时间的踝部制动及术后软组织粘连，易造成腓肠肌挛缩，从而诱发创伤后马蹄足。若不及时进行合理有效的治疗，容易引发跖腱膜炎、外翻、获得性平足症、前跖痛等并发症。目的：探讨腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩型马蹄足的效果。方法：2011年1月至2013年1月，通过腓肠肌腱膜切断松解术治疗踝关节骨折术后腓肠肌挛缩患者26例，男17例，女9例，年龄24~55岁，平均44.3岁。术前对所有患者伸膝及屈膝90°时的踝关节背屈角度进行测量，确诊为踝关节骨折术后腓肠肌挛缩。采用改良的Strayer手术对腓肠肌松解。采用美国足踝外科协会（AOFAS）踝-后足评分评估患足功能。术后再次对伸膝及屈膝90°时的踝关节背屈角度进行测量并与术前比较。结果：21例患者获得随访，随访时间12~24个月，平均17个月。所有切口均一期愈合，无感染，无腓肠神经损伤，无明显疼痛不适。伸膝状态下踝关节背屈角度由术前的0.9°±3.4°恢复到术后的13.6°±2.4°（P＜0.01）。术后AOFAS踝-后足评分为（80.9±5.7）分，与术前（57.6±6.4）分，比较差异亦有统计学意义（P＜0.01）。结论：对于踝关节骨折后并发的腓肠肌型马蹄足，腓肠肌腱松解术操作简单，创伤小，可获得满意疗效。
배경：족과부창상가도치환자교장시간적과부제동급술후연조직점련，역조성비장기련축，종이유발창상후마제족。약불급시진행합리유효적치료，용역인발척건막염、외번、획득성평족증、전척통등병발증。목적：탐토비장기건막절단송해술치료과관절골절술후비장기련축형마제족적효과。방법：2011년1월지2013년1월，통과비장기건막절단송해술치료과관절골절술후비장기련축환자26례，남17례，녀9례，년령24~55세，평균44.3세。술전대소유환자신슬급굴슬90°시적과관절배굴각도진행측량，학진위과관절골절술후비장기련축。채용개량적Strayer수술대비장기송해。채용미국족과외과협회（AOFAS）과-후족평분평고환족공능。술후재차대신슬급굴슬90°시적과관절배굴각도진행측량병여술전비교。결과：21례환자획득수방，수방시간12~24개월，평균17개월。소유절구균일기유합，무감염，무비장신경손상，무명현동통불괄。신슬상태하과관절배굴각도유술전적0.9°±3.4°회복도술후적13.6°±2.4°（P＜0.01）。술후AOFAS과-후족평분위（80.9±5.7）분，여술전（57.6±6.4）분，비교차이역유통계학의의（P＜0.01）。결론：대우과관절골절후병발적비장기형마제족，비장기건송해술조작간단，창상소，가획득만의료효。
Background:Foot and ankle trauma often results in long-term immobilization and soft-tissue adhesion, which can cause gas-trocnemius contracture and posttraumatic equinus. If there is not effective treatment, complications such as plantar fascia, hallux valgus, acquired flatfoot and metatarsalgia will occur. Objective:To explore outcome of gastrocnemius recession on gastrocnemius contracture resulted from ankle fractures. Methods:A total of 26 patients with gastrocnemius contracture after ankle fractures were treated by gastrocnemius recession from January 2011 to January 2013. There were 17 males and 9 females with an average age of 44.3 years (ranged from 24 to 55 years). The angle of ankle dorsiflexion was recorded when the knee was extended and bent. AOFAS ankle-hindfoot score was used to assess foot function. Postoperative measurements were compared with preoperative ones. The surgical technique used was previously described by Strayer and later modified by Hansen. Results:Finally, 21 patients were followed up for 17 months on average (ranged from 12 to 24 months). Primary healing was achieved in all patients. No infections, injury of sural nerve or severe pain were found. The angle of ankle dorsiflexion when the knee extended increased from preoperative 0.9°±3.4° to postoperative 13.6°±2.4°(P<0.01). AOFAS score was sig-nificantly increased after surgery (80.9±5.7 vs 57.6±6.4, P<0.01). Conclusions: As to equinus of gastrocnemius contracture resulted from ankle fractures, gastrocnemius recession is per-formed easily and were less invasive. It can lead to a favorable outcome.