腓骨长肌腱转位修复长段陈旧性跟腱缺损疗效分析  

Therapeutic effect on transposition of peroneal longus tendon in reconstruction of long segment defect of chronic Achilles tendon rupture

作　　者：刘迪 谭杨[2] 张浩[1] 喻爱喜[1] 潘振宇[1] LIU Di;TAN Yang;ZHANG Hao;YU Aixi;PAN Zhenyu(Department of Trauma and Micro-orthopaedics,Zhongnan Hospital of Wuhan University,Wuhan 430000,China;Department of Joint and Sports Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430000,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430000 [2]武汉大学中南医院关节与运动医学科,武汉430000

出　　处：《中华显微外科杂志》2023年第5期516-521,共6页Chinese Journal of Microsurgery

基　　金：湖北省财政厅资助科研类项目(KYXM2023006)。

摘　　要：目的探讨腓骨长肌腱转位修复长段陈旧性跟腱断裂的疗效。方法2013年11月-2018年11月,武汉大学中南医院创伤与显微骨科收治的17例长段陈旧性跟腱断裂(缺损大于5.0 cm以上)患者,男14例,女3例,年龄为19~55岁,平均34.7岁,左侧11例,右侧6例,病程为1~12个月,平均3.8个月。跟腱断端位于距止点0~5.0 cm处,术中清理断端后缺损长度5.0~9.0 cm。彻底清除跟腱断端瘢痕组织后行自体腓骨长肌腱转位跟腱重建术,术后随访观察伤口等并发症情况,术前和末次门诊随访时采用Arner-Lindholm疗效评定,美国矫形足踝外科协会(AOFAS)踝-后足评分及跟腱断裂总评分(ATRS)评价功能恢复情况,末次随访时观测患侧单足提踵活动、双小腿最大周径、步态分析评估足底应力,复查踝关节CT及MRI。在SPSS 22.0软件中使用t检验,对术前和术后AOFAS和ATRS评分进行比较,P<0.05为差异有统计学意义。结果纳入研究的17例患者中1例糖尿病患者术后出现伤口血肿,经清创联合VSD治疗后愈合,其余患者伤口均一期愈合。术后随访24~48个月,平均33个月,根据Arner-Lindholm疗效评定结果为:优11例,良6例,AOFAS由术前(62.94±6.51)分提高至术后(93.71±6.15)分,ATRS由术前(29.00±3.54)分提高至术后(92.29±3.02)分,手术前后的评分差异均有统计学意义(P<0.05)。所有患者未出现跟腱再次断裂、伤口感染、神经损伤等并发症。随访时踝关节功能均恢复良好,外翻有力,可行单足提踵动作,患侧小腿周径小于健侧周径均不超过1.5 cm,步态分析显示足底应力分布均衡,患肢和健侧均无胼胝形成;所有患者复查踝关节CT均无明显骨性关节炎表现,踝关节MRI显示重建跟腱连续性好,较术后明显增粗。结论腓骨长肌腱转位重建断端缺损较长或跟腱于止点处断裂的陈旧性跟腱断裂是一种较为简单并且有效的手术方式。Objective To explore the therapeutic effect on transposition of peroneal longus tendon in reconstruction of long segment defects of chronic Achilles tendon.Methods From November 2013 to November 2018,17 patients with long segment defects of chronic Achilles tendon(greater than 5.0 cm of defect)were admitted in the Department of Trauma and Micro-orthopaedics of Zhongnan Hospital of Wuhan University.The patients were 14 males and 3 females,aged 19-55 years old,with an average of 34.7 years old.Eleven patients had defects on left Achilles tendon and 6 on the right.The chronic defects lasted over 1-12 months with an average of 3.8 months.The broken ends of the Achilles tendon located at 0-5.0 cm from the insertion point.The defects were at 5.0-9.0 cm in length,after debridement of the broken ends.After thoroughly debridement of the scar tissue over the broken end of an Achilles tendon,an autologous peroneal tendon transposition was performed for reconstruction of an Achilles tendon.Postoperative follow-ups were conducted to observe wound healing and complications.Arner Lindholm score was employed to evaluate the therapeutic efficacy before surgery and at the final follow-up.Ankle-hindfoot score of American Orthopedic Foot and Ankle Society(AOFAS)and Achilles Tendon Total Rupture Score(ATRS)were used to evaluate functional recovery.At the final follow-up,heel raise of single affected foot and the maximum circumference of both calves were observed,gait analyses for plantar stress assessment as well as review of ankle CT and MRI scans were conducted for assessment of therapeutic efficacy.Using t test in SPSS 22.0 software to compare preoperative and postoperative AOFAS and ATRS scores,P<0.05 indicates a statistically significant difference.Results Wounds healed in one stage,except 1 diabetic patient who had haematoma in the wound after surgery and healed after debridement combined with VSD treatment.All the 17 patients had completed the postoperative follow-up that lasted for 24-48 months,with an average of 33 months.Ac

关 键 词：陈旧性跟腱断裂 腓骨长肌腱转位 跟腱断裂总评分 步态分析 

分 类 号：R687.3[医药卫生—骨科学]