深低温冷冻保存同种异体肌腱移植修复陈旧性跟腱断裂研究  

Research on cryopreserved allograft tendon transplantation in repairing old Achilles tendon rupture

作　　者：沙勇[1] 李福兵[1] 唐辉[1] 朱跃良[1] 简红[1] 徐永清[1] 赵万秋[1] 李霞[1] 李春晓[1] 陈海东[1] 高定[1] 黄飞[1] 

机构地区：[1]成都军区昆明总医院附属骨科医院(全军创伤骨科研究所),昆明650032

出　　处：《西南国防医药》2014年第7期707-709,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：云南省应用基础研究自筹项目(2011FZ312);成都军区"十二五"重点项目(B12020)

摘　　要：目的：探讨深低温冷冻保存同种异体肌腱移植修复陈旧性跟腱断裂的临床效果。方法2010年1月-2012年9月收治急性创伤所致跟腱断裂一期未行修复导致的陈旧性跟腱断裂患者共32例，缺损长度3-6（4.6±1.0）cm，手术所用肌腱为经过深低温处理的同种异体胫前肌肌腱。在跟腱远端和近端用2-0可吸收抗菌薇乔采用双束 Kessler 法端端吻合，术后常规跖屈20-30°位固定踝关节，足背肢具或石膏板固定4-6 w。3例合并皮肤缺损者，行腓肠神经营养皮瓣转移覆盖创面。术后采用美国足踝外科协会（ AOFAS）踝与后足评分行疗效评价。结果术后32例均获随访1年以上，平均随访（15.0±3.5）个月，其中29例切口Ⅰ期愈合，2例切口Ⅱ期愈合，1例因为排异反应取出移植肌腱由于疤痕愈合未行再次肌腱移植，目前可以正常行走。术后踝关节功能恢复良好，AOFAS 足踝评分从术前（50.5±5.5）分提高到术后（90.5±6.5）分。结论修复陈旧性跟腱断裂可用深低温冷冻保存同种异体肌腱，手术效果可，并可避免取自体腱造成二次损伤和并发症，患者更容易接受，移植物可长期保存，但长期效果仍需长期随访。Objective To explore the clinical effect of cryopreserved allograft tendon transplantation in repairing old Achilles tendon rupture. Methods 32 cases with old Achilles tendon rupture caused by acute trauma hospitalized in the period from Jan. ,2010 to Sept. ,2012 were selected;the defects were 3-6 cm long with the average length of（4. 6 ± 1. 0）cm;the tendons used in the operation were cryopreserved allograft tendons of tibialis anterior muscle;Kessler method was applied to end to end anastomosis with 2-0 absorbable Vicryl at the distal and proximal end of the tendon;after surgery,the ankle joint was fixed at routine plantar flexion 20-30＆#176;;fixation with coasting or plasterboard lasted from 4 weeks to 6 weeks;sural nerve flap transplantation was made to cover the wound in 3 cases complicated with skin defects;the score of American Orthopedic Foot and Ankle Society（AOFAS）was adopted in the evaluation of curative effect. Results Follow-up lasted for over 1 year with the average of（15.0 ±3.5）months;incision primary healing was found in 29 cases and secondary healing in 2 cases;graft rejection was found in 1 case and the transplanted tendon had to be removed;ankle joint function recovered well after surgery, AOFAS scores went from（50.5 ± 5. 5）before surgery up to（90. 5 ± 6. 5）after surgery. Conclusions Old Achilles tendon rupture can be effectively repaired by cryopreserved allograft tendon,which avoids the second injury caused by autologous tendon and is easy for patients to accept;the graft can be stored for long;while the long-term effect needs follow-up of long period.

关 键 词：胫前肌 肌腱 陈旧性 跟腱缺损 同种异体 移植 

分 类 号：R622.2[医药卫生—整形外科]