[足母]长屈肌转位联合腓肠肌腱条翻转桥接修复陈旧跟腱断裂的临床体会  

Clinical experience of transposition of the flexor hallucis longus muscle combined with bridging of the sural tendon for repairing old achilles tendon rupture

作　　者：张兆飞 武俊旗 孔德伟 马重兴 栗贡策 高鑫 明立彪 Zhang Zhaofei;Wu Junqi;Kong Dewei;Ma Chongxing;Li Gongce;Gao Xin;Ming Libiao(Hua County Bone-setting Hospital of Henan Province,Anyang 456463,China)

机构地区：[1]河南省滑县正骨医院,河南安阳456463

出　　处：《足踝外科电子杂志》2023年第1期33-36,50,共5页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的探讨应用[足母]长屈肌转位联合腓肠肌腱条翻转桥接修复陈旧跟腱断裂的临床疗效及手术方法。方法2016年1月至2022年12月,河南省滑县正骨医院应用[足母]长屈肌转位重建跟骨止点联合腓肠肌腱条翻转桥接跟腱修复陈旧跟腱断裂患者12例,跟腱断裂时间最短1个月,最长5年以上,男9例,女3例,年龄42~68岁,平均年龄54.3岁,跟腱缺损长度为5~8 cm,分别在术后3周、6周、8周、3个月、6个月、12个月随访,随访期间,早期调整石膏,后期指导功能锻炼。结果本组12例陈旧跟腱断裂患者的患足重新获得提踵功能,恢复了正常行走及工作,疼痛及跛行症状消失,无跟腱再断裂。其中1例切口愈合不良,通过正常换药联合电磁波治疗仪照射后愈合,无感染,该例患者BMI偏高。另外,12例病例均获得切口I期愈合。术后,12例患者最长随访时间超过2年,切口瘢痕无异常增生,无瘢痕皮肤磨损破溃,患肢腓肠肌萎缩恢复,小腿围周长与健侧接近,患足可提踵,提踵力量略弱于健足,可满足正常行走及劳作,恢复一定跑跳能力,美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分及跟腱完全断裂评分(achilles tendon total rupture score,ATRS)均在90分以上。结论使用[足母]长屈肌转位重建跟骨止点联合腓肠肌腱条翻转桥接断裂跟腱的临床效果良好,提踵力量强,牢固程度高,减少切口缝合张力,并发症少,可相对较早进行负重锻炼,有效改善跛行不适,是一种修复陈旧跟腱断裂的可靠方法。Objective To investigate the clinical effect and surgical method of repairing old achilles tendon rupture by transposition of flexor hallucis longus combined with gastrocnemius tendon strip.Methods From January 2016 to December 2022,12 cases of old achilles tendon rupture were repaired by transposition of flexor hallucis longus combined with bridging achilles tendon.The shortest time of achilles tendon rupture was 1 month and the longest time of rupture was more than 5 years,including 9 males,There were 3 women,aged 42~68 years,with an average age of 54.3 years.The length of achilles tendon defect was 5~8 cm.They were followed up at 3 weeks,6 weeks,8 weeks,3 months,6 months and 12 months respectively.During the follow-up period,plaster was adjusted early and functional exercise was guided later.Results 12 patients with old achilles tendon rupture regained heel lifting function,resumed normal walking and work,disappeared pain and claudication symptoms,and no achilles tendon rupture occurred.One case of poor wound healing healed after normal dressing change combined with TDP therapeutic instrument irradiation without infection.The patient's BMI was overweight,and the other cases achieved primary wound healing.The longest follow-up time of 12 patients after operation was more than 2 years.There was no abnormal hyperplasia of incision scar,no abrasion and collapse of scar skin,the gastrocnemius muscle atrophy of the affected limb recovered,the circumference of the lower leg was close to the healthy side,the affected foot could lift the heel,and the heel lifting force was slightly weaker than the healthy foot,which met the normal walking and work,and recovered a certain running and jumping ability.The(American Orthopedic Foot and Ankle Society,AOFAS)score and(achilles tendon total rupture score,ATRS)score were more than 90 points.Conclusion The method of using transposed flexor pollicis longus to reconstruct the calcaneal stop combined with sural tendon strip to flip and bridge the broken achilles tendon has good clin

关 键 词：跟腱断裂 陈旧损伤 [足母]长屈肌转位 腓肠肌腱条翻转桥接 修复 

分 类 号：R687.2[医药卫生—骨科学]