自体半束腓骨长肌腱移植重建术治疗陈旧性跟腱断裂伴缺损的疗效  

Efficacy of reconstruction with half of peroneous longus tendon autograft for the treatment of chronic Achilles tendon rupture combined with tendon defects

作　　者：赵廷崴 李箭[1] 蔡武峰 陈坤豪 李棋[1] Zhao Tingwei;Li Jian;Cai Wufeng;Chen Kunhao;Li Qi(Orthopedic Sports Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科运动医学中心,成都610041

出　　处：《中华创伤杂志》2024年第2期162-167,共6页Chinese Journal of Trauma

摘　　要：目的探讨自体半束腓骨长肌腱移植重建术治疗陈旧性跟腱断裂伴缺损的疗效。方法采用回顾性病例系列研究分析2017年11月至2020年8月四川大学华西医院收治的14例陈旧性跟腱断裂伴缺损患者的临床资料,其中男11例,女3例;年龄26~62岁[(42.8±10.7)岁]。均行自体半束腓骨长肌腱移植重建术治疗。比较术前、术后12个月及末次随访时美国足踝外科协会(AOFAS)评分、跟腱完全断裂评分(ATRS)、视觉模拟评分(VAS)。末次随访时评估患侧MRI影像学以判断跟腱愈合情况;复查Thompson试验并检查患者是否能完成单踝提踵;询问患者重返日常生活、运动情况。观察术后并发症发生情况。结果患者均获随访24~47个月[(35±9)个月]。术后12个月AOFAS评分、ATRS和VAS分别为(87.9±6.6)分、(80.9±2.4)分、(2.0±0.3)分,均优于术前的(52.7±16.9)分、(42.0±4.4)分、(4.1±0.4)分(P<0.05);末次随访时AOFAS评分、ATRS和VAS分别为(95.2±7.2)分、(85.9±2.5)分、(0.8±0.3)分,均优于术后12个月(P<0.05)。末次随访时患侧踝关节MRI示断裂跟腱愈合良好。末次随访时Thompson试验为阴性,患者均能完成患侧单足提踵。末次随访时患者均恢复日常生活活动,其中5例恢复篮球等中高强度运动及中高强度体能训练,5例恢复慢跑、游泳等低强度运动,其余4例由于担心再次受伤或随着年龄的增长而不再参与体育运动。1例出现伤口延迟愈合,考虑与痛风相关。1例术后诉天冷或久走后跟腱轻微疼痛。所有患者术后未发生跟腱再次断裂,未诉取腱部位不适或足外翻及踝跖屈受限。结论自体半束腓骨长肌腱移植重建术治疗陈旧性跟腱断裂伴缺损,患者术后踝关节功能显著改善,疼痛明显缓解,重返生活、运动情况基本满意,并发症少。Objective To evaluate the outcomes of reconstruction with half of peroneous longus tendon autograft for the treatment of chronic Achilles tendon rupture combined with tendon defects.Methods A retrospective case series study was conducted on the clinical data of 14 patients with chronic tendon rupture combined with defects admitted to Orthopedic Sports Medicine Center,West China Hospital,Sichuan University from November 2017 to August 2020,including 11 males and 3 females,aged 26-62 years[(42.8±10.7)years].All the patients underwent Achilles tendon reconstruction with half of peroneus longus tendon autograft.American Orthopedic Foot and Ankle Society(AOFAS)score,Achilles tendon total rupture score(ATRS)and Visual Analogue Scale(VAS)were compared before surgery,at 12 months after surgery and at the last follow-up.At the last follow-up,MRI of the injured ankle was prescribed to evaluate tendon healing;Thomspon test was performed and the patients were asked to do single-leg heel raise;the patients were asked about their conditions in returning to daily life activities and sports.Postoperative complications were observed.Results All the patients were followed up for 24-47 months[(35±9)months].AOFAS score,ATRS and VAS at 12 months after surgery were(87.9±6.6)points,(80.9±2.4)points and(2.0±0.3)points respectively,superior to those before surgery[(52.7±16.9)points,(42.0±4.4)points and(4.1±0.4)points respectively](P<0.05).The afore-mentioned results at the last follow-up were(95.2±7.2)points,(85.9±2.5)points and(0.8±0.3)points respectively,superior to those at 12 months after surgery(P<0.05).MRI images of the affected ankle joints showed satisfactory healing of the reconstructed Achilles tendon at the last follow-up.All the patients,being negative in Thompson test at the last follow-up,were able to complete the heel lift on the affected side.All the patients resumed activities of daily living at the last follow-up,among whom 5 resumed to moderate-to high-intensity sports activities,such as basketball sport,and

关 键 词：跟腱 腱损伤 移植 自体 

分 类 号：R687[医药卫生—骨科学]