自体腘绳肌腱联合长屈肌腱转移重建跟腱的疗效观察  

EFFECTIVENESS OF HAMSTRING TENDON AND FLEXOR HALLUCIS LONGUS TENDON AUTOGRAFT FOR Achilles TENDON DEFECTS RECONSTRUCTION

作　　者：齐进[1] 夏亚一[1] 汪玉良[1] 赵琳[1] 姚长江[1] 

机构地区：[1]兰州大学第二医院骨科,兰州730030

出　　处：《中国修复重建外科杂志》2013年第10期1202-1205,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的临床疗效。 方法2009年2月－2011年10月，采用自体腘绳肌腱联合（足母）长屈肌腱转移重建9例9足跟腱缺损。男6例，女3例；年龄21～65岁，平均43岁。其中运动伤导致陈旧性跟腱断裂伴缺损5例；跟腱病变切除后跟腱缺损4例，其中跟腱纤维玻璃样变伴坏死2例、跟腱巨细胞瘤1例、跟腱慢性炎症伴玻璃样变1例。病程31～387 d，平均137.6 d。跟腱缺损长度为5～18 cm，平均8.6 cm。术后踝关节石膏固定6周后开始功能锻炼。 结果术后2例发生切口裂开、渗液，1例出现胫神经损伤导致的足底疼痛；余患者切口均Ⅰ期愈合，无相关并发症发生。9例患者均获随访，随访时间13～25个月，平均19.7个月。随访期间均无重建肌腱断裂发生。术后1年及末次随访时踝关节背伸活动度与术前比较差异无统计学意义（P 〉 0.05），踝关节跖屈活动度均显著大于术前（P 〈 0.05）。术后1年及末次随访时踝关节跖屈、背伸活动度均显著大于术后3个月（P 〈 0.05），末次随访时与术后1年比较差异均无统计学意义（P 〉 0.05）。患者术后美国矫形足踝协会（AOFAS）及简明健康调查量表（SF-36量表）评分均较术前显著提高，且末次随访时评分显著高于术后3个月时，差异均有统计学意义（P 〈 0.05）。末次随访时，跟腱修复术后临床疗效评分（ATRS）亦显著高于3个月时，差异有统计学意义（t= —7.982，P=0.000）。 结论自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱疗效确切。ObjectiveTo evaluate the effectiveness of hamstring tendon and flexor hallucis longus （FHL） tendon autograft for Achilles tendon defects reconstruction. MethodsBetween February 2009 and October 2011, 9 patients （9 feet） with Achilles tendon defect were treated with hamstring tendon and FHL tendon autograft. Of 9 cases, 6 were male and 3 were female with an average age of 43 years （range, 21-65 years）, including 5 cases of chronic Achilles tendon ruptures caused by sport injury and 4 cases of Achilles tendon defects caused by resection of tendon lesion （2 cases of hyaline degeneration with necrosis, 1 case of giant cell tumor, and 1 case of chronic inflammation with hyaline degeneration）. The disease duration ranged from 31 to 387 days （mean, 137.6 days）. The defect length was 5 to 18 cm （mean, 8.6 cm）. Functional exercise of the ankle began at 6 weeks after plaster fixation. ResultsDehiscence and effusion occurred in 2 cases and plantar pain caused by injury of tibial nerve in 1 case; primary healing of wound was obtained in the other patients without complication. Nine patients were followed up 19.7 months on average （range, 13-25 months）; no re-rupture was observed. There was no significant difference in the dorsal extension between at preoperation and at 1 year and last follow-up after operation （P 〉 0.05）; the ankle plantar flexion at 1 year and last follow-up after operation was significantly larger than that at preoperation （P 〈 0.05）. The ankle plantar flexion and dorsal extension at 1 year and last follow-up after operation were significantly larger than those at 3 months after operation （P 〈 0.05）, but no significant difference was found between at 1 year and last follow-up （P 〉 0.05）. American Orthopaedic Foot and Ankle Society （AOFAS） and short-form 36 health survey scale （SF-36） scores were significantly increased at postoperation when compared with scores at preoperation （P 〈 0.05）, and the scores at last follow-up were significantly h

关 键 词：跟腱缺损 腘绳肌腱 （足母）长屈肌腱 跟腱重建 

分 类 号：R687.2[医药卫生—骨科学]