CAJ | 학술논문

目的回顾性分析Ilizarov技术结合肌腱延长术治疗创伤性跟腱挛缩的临床效果. 方法回顾性分析2011年3月至2014年12月收治的27例创伤性跟腱挛缩患者资料,男16例,女11例;年龄13 ～52岁,平均31.2岁;左侧13例,右侧14例.单纯性跟腱挛缩18例,合并有其他足畸形9例.小腿软组织和骨折创伤引起19例,缺血性挛缩后5例,另外有3例原因不明.根据患足X线片胫底角的不同进行分度治疗,手术方法包括Ilizarov环式外固定后推、前拉治疗,跟腱、胫骨后肌腱、躅长屈肌腱、趾长屈肌腱松解术,足部分关节融合术.术后第7天开始矫形,参考速度为1 mm/d.患者术后牵张矫形到踝背伸80°停止,矫形时间为15 ～32 d,平均23 d;到位后固定角度不变6周.拆除外固定支架,行石膏或支具固定3个月后拆除.结果 27例患者术后获6～36个月(平均20个月)随访,其中25例(92.6％)患者的胫底角均为90°,患者行走步态自然;2例(7.4％)患者胫底角反弹为105°,需要垫高后跟鞋垫后恢复自然行走.9例遗留足趾的屈趾畸形,未做进一步处理. 结论以Ilizaroy技术为主,结合肌腱延长术治疗创伤性跟腱挛缩有效、安全、复发率低.
목적 회고성분석Ilizarov기술결합기건연장술치료창상성근건련축적림상효과. 방법 회고성분석2011년3월지2014년12월수치적27례창상성근건련축환자자료,남16례,녀11례;년령13 ～52세,평균31.2세;좌측13례,우측14례.단순성근건련축18례,합병유기타족기형9례.소퇴연조직화골절창상인기19례,결혈성련축후5례,령외유3례원인불명.근거환족X선편경저각적불동진행분도치료,수술방법포괄Ilizarov배식외고정후추、전랍치료,근건、경골후기건、촉장굴기건、지장굴기건송해술,족부분관절융합술.술후제7천개시교형,삼고속도위1 mm/d.환자술후견장교형도과배신80°정지,교형시간위15 ～32 d,평균23 d;도위후고정각도불변6주.탁제외고정지가,행석고혹지구고정3개월후탁제.결과 27례환자술후획6～36개월(평균20개월)수방,기중25례(92.6％)환자적경저각균위90°,환자행주보태자연;2례(7.4％)환자경저각반탄위105°,수요점고후근혜점후회복자연행주.9례유류족지적굴지기형,미주진일보처리. 결론 이Ilizaroy기술위주,결합기건연장술치료창상성근건련축유효、안전、복발솔저.
Objective To report treatment of post-traumatic Achilles tendon contracture with Ilizarov technique and tendon lengthening.Methods From March 2011 to December 2014,27 cases of post-traumatic Achilles tendon contracture were treated at our department.They were 16 males and 11 females,13 to 52 years of age (average,31.2 years).The left side was affected in 13 cases and the right side in 14.Eighteen cases had simple Achilles tendon contracture while the other 9 were complicated with other foot deformities.The causes were soft tissue injury and fracture at the leg in 19 cases,Volkmann's contracture in 5,and unknown in 3.Based on the X-ray tibio-sole angle of the affected foot,the treatment protocols included Ilizarov distraction,lengthening of the Achilles tendon,tibialis posterior,flexor hallucis longus and flexor digitorum longus,and partial fusion of the foot joint.The deformity correction with the Ilizarov device started from the postoperative 7 days with a rate of 1 mm/day and continued until the ankle reached a dorsal flexion of 80°.This period lasted from 15 to 32 days (average,23 days).The fixation was maintained for 6 weeks after the fixation angle was stabilized.After the external fixators were removed,the ankle was fixated with plaster or splints for 3 months.Results The follow-ups ranged from 6 to 36 months (average,20 months).At the last follow up,25 cases (92.6％) achieved a tibio-sole angle of 90° and natural walking postures.Two patients (7.4％) who had the tibo-sole angle rebounded to 105° needed a pad at the posterior sole to recover natural walking.Nine patients had foot digital flexion deformities which were not treated further.Conclusion For post-traumatic Achilles tendon contracture,Ilizarov technique combined with tendon lengthening is fairly effective and safe,leading to a low rate of recurrence.