中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
4期
354-359
,共6页
苗旭东%吴永平%陶惠民%杨迪生
苗旭東%吳永平%陶惠民%楊迪生
묘욱동%오영평%도혜민%양적생
跟腱%腱损伤%腱转移术%外科手术,微创性
跟腱%腱損傷%腱轉移術%外科手術,微創性
근건%건손상%건전이술%외과수술,미창성
Achilles tendon%Tendon injuries%Tendon transfer,Surgical procedures,minimally invasive
目的 探讨微创切取全长(足母)长屈肌腱重建陈旧性KuwadaⅣ型跟腱断裂的临床效果.方法 回顾性分析2006年7月至2011年6月,微创切取全长(足母)长屈肌腱重建35例陈旧性KuwadaⅣ型跟腱断裂患者资料,男21例,女14例；年龄为23～71岁,平均42.1岁；均为单侧损伤.MRI示跟腱断裂间隙为6.0～9.2 cm.观察术后踝关节外形及功能恢复情况,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及Leppilahti跟腱修复评分评价疗效.结果 32例获得随访,随访时间为18～72个月,平均33.2个月.除1例患者因术后10d拆线致切口裂开重新缝合6周后获得延迟愈合外,其余患者切口均一期愈合.术后踝关节外形及功能恢复良好,AOFAS踝与后足评分从术前(51.92±7.08)分提高到术后(92.56±6.71)分；其中优27例,良3例,可2例,优良率为93.8％(30/32).Leppilahti跟腱修复评分从术前(72.56±7.43)分提高到术后(92.58±5.1)分.无一例发生腓肠神经及胫神经损伤、跖部痛性瘢痕、足底内外侧神经损伤.踝关节MRI示跟腱部信号均匀无撕裂和囊性变.结论 微创切取(足母)长屈肌腱转移重建陈旧性KuwadaⅣ跟腱断裂具有术后恢复快、肌腱固定强度高、并发症少的优点.
目的 探討微創切取全長(足母)長屈肌腱重建陳舊性KuwadaⅣ型跟腱斷裂的臨床效果.方法 迴顧性分析2006年7月至2011年6月,微創切取全長(足母)長屈肌腱重建35例陳舊性KuwadaⅣ型跟腱斷裂患者資料,男21例,女14例；年齡為23～71歲,平均42.1歲；均為單側損傷.MRI示跟腱斷裂間隙為6.0～9.2 cm.觀察術後踝關節外形及功能恢複情況,併採用美國足踝外科協會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與後足評分及Leppilahti跟腱脩複評分評價療效.結果 32例穫得隨訪,隨訪時間為18～72箇月,平均33.2箇月.除1例患者因術後10d拆線緻切口裂開重新縫閤6週後穫得延遲愈閤外,其餘患者切口均一期愈閤.術後踝關節外形及功能恢複良好,AOFAS踝與後足評分從術前(51.92±7.08)分提高到術後(92.56±6.71)分；其中優27例,良3例,可2例,優良率為93.8％(30/32).Leppilahti跟腱脩複評分從術前(72.56±7.43)分提高到術後(92.58±5.1)分.無一例髮生腓腸神經及脛神經損傷、蹠部痛性瘢痕、足底內外側神經損傷.踝關節MRI示跟腱部信號均勻無撕裂和囊性變.結論 微創切取(足母)長屈肌腱轉移重建陳舊性KuwadaⅣ跟腱斷裂具有術後恢複快、肌腱固定彊度高、併髮癥少的優點.
목적 탐토미창절취전장(족모)장굴기건중건진구성KuwadaⅣ형근건단렬적림상효과.방법 회고성분석2006년7월지2011년6월,미창절취전장(족모)장굴기건중건35례진구성KuwadaⅣ형근건단렬환자자료,남21례,녀14례；년령위23～71세,평균42.1세；균위단측손상.MRI시근건단렬간극위6.0～9.2 cm.관찰술후과관절외형급공능회복정황,병채용미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족평분급Leppilahti근건수복평분평개료효.결과 32례획득수방,수방시간위18～72개월,평균33.2개월.제1례환자인술후10d탁선치절구렬개중신봉합6주후획득연지유합외,기여환자절구균일기유합.술후과관절외형급공능회복량호,AOFAS과여후족평분종술전(51.92±7.08)분제고도술후(92.56±6.71)분；기중우27례,량3례,가2례,우량솔위93.8％(30/32).Leppilahti근건수복평분종술전(72.56±7.43)분제고도술후(92.58±5.1)분.무일례발생비장신경급경신경손상、척부통성반흔、족저내외측신경손상.과관절MRI시근건부신호균균무시렬화낭성변.결론 미창절취(족모)장굴기건전이중건진구성KuwadaⅣ근건단렬구유술후회복쾌、기건고정강도고、병발증소적우점.
Objective To explore clinical effect of reconstruction for chronic Achilles tendon rupture of Kuwada IV type with flexor hallucis longus (FHL) harvested using a minimally invasive technique.Methods The data of 35 patients with chronic Achilles tendon rupture of Kuwada IV type was retrospectively analyzed who were treated by FHL which was harvested using a minimally invasive technique from July 2006 to June 2011.There were 21 males and 14 females,with the age from 23 to 71 years (average,42.1 years).All patients were unilateral injury.MRI showed Achilles tendon rupture fissures 6.0-9.2 cm.The local appearance and function recovery on postoperation was observed,and all patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Leppilahti Achilles tendon repair score.Results Thirty-two patients were followed up for 18 to 72 months,with an average of 33.2 months.Except for 1 patient whose wound healed after six weeks through resuture immediately for the wound dehiscence occurred in the ten days,other patients' wound healed smoothly.The average of AOFAS ankle-hindfoot score had increased from 51.92±7.08 preoperatively to 92.56±6.71 postoperatively.Leppilahti Achilles tendon repair score had increased from 72.56±7.43 preoperatively to 92.58±5.1 postoperatively.Twenty-seven cases were excellent,good in 3,and fair in 2,with the total excellent and good rate 93.8％ (30/32).No case of the sural nerve and tibial nerve injury,plantar painful scar,plantar outside nerve injury.MRI of Achilles tendon showed even signal without signal of tear and cystic degeneration.Conclusion Reconstruction for chronic Achilles tendon rupture of Kuwada IV type with FHL harvested using a minimally invasive technique offers a desirable outcome in rapid postoperative recovery,high strength in tenodesis,fewer complications.
