单切口踇长屈肌腱转位治疗Haglund综合征并发急性跟腱断裂  

Single-incision flexor hallucis longus tendon transfer for the treatment of Haglund syndrome complicated with acute Achilles tendon rupture

作　　者：林世伟 富珂 许晨雨 方真华 Lin Shiwei;Fu Ke;Xu Chenyu;Fang Zhenhua(Postgraduate Training Base,Wuhan Fourth Hospital,Hubei University of Medicine,Shiyan Hubei,442000;Department of Foot and Ankle Surgery,Wuhan Fourth Hospital,Wuhan Hubei,430030,China)

机构地区：[1]湖北医药学院武汉市第四医院研究生培养基地,湖北十堰442000 [2]武汉市第四医院足踝外科,湖北武汉430030

出　　处：《生物骨科材料与临床研究》2024年第5期27-31,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨单切口跟骨后上结节及变性跟腱切除,踇长屈肌腱转位术治疗Haglund综合征并发急性跟腱断裂的临床疗效。方法回顾性分析武汉市第四医院足踝外科2018年1月至2020年1月收治的40例Haglund综合征并发急性跟腱断裂患者的临床资料,均行跟骨后上结节切除,踇长屈肌腱转位术。记录患者术前、术后3个月、术后6个月及末次随访的美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝与后足功能评分、维多利亚运动评估学院-跟腱问卷(Victorian Institute of Sports Assessment-Achilles questionnaire, VISA-A)、跟腱完全断裂评分(Achilles tendon total rupture score, ATRS)及Leppilahti评分评价临床结果。末次随访时采用Arner-Lindholm评分标准评估疗效。记录测量患者术前、术后3个月、术后6个月及末次随访的跟骨后角(Fowler-Philipp angle, FPA)、X/Y比值和平行间距线(parallel pitch lines, PPL)评价影像学结果。结果40例患者均获得随访,随访时间为(16.87±2.78)个月(12~24个月)。患者均顺利完成手术,无神经、血管损伤等并发症。与术前相比,术后3个月、术后6个月及末次随访时AOFAS评分、ATRS评分、Leppilahti评分及VISA-A评分显著增加,差异有统计学意义(P<0.05)。采用Arner-Lindholm评分标准,临床结果评定为优36足,良4足,优良率为100%。所有患者切口一期愈合,踝关节背伸跖屈功能正常。影像学方面,与术前相比,术后3个月,术后6个月及末次随访时,FPA显著减小,X/Y比值显著增大,差异有统计学意义(P<0.05),PPL阳性率由术前的100%减少为7.5%,影像学表现显著改善。结论对于Haglund综合征并发急性跟腱断裂的患者,应用单切口跟骨结节及变性跟腱切除,踇长屈肌腱转位的手术可获得满意的临床疗效,该术式具有操作简单、肌腱固定坚强可靠,术后并发症少等优点,术后可以有效解除患者痛苦,恢复跟腱功能,值得临床推广�Objective To investigate the clinical efficacy of single-incision excision of the retrocalcaneal exostosis and degenerated Achilles tendon,combined with flexor hallucis longus tendon transfer,in the treatment of acute Achilles tendon rupture with Haglund syndrome.Methods A retrospective analysis was conducted on the clinical data of 40 patients with Haglund syndrome complicated with acute Achilles tendon rupture who were treated at the department of foot and ankle surgery of Wuhan Fourth Hospital from January 2018 to January 2020.All patients underwent excision of the retrocalcaneal exostosis and flexor hallucis longus tendon transfer.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot functional scores,Victorian Institute of Sports Assessment-Achilles questionnaire(VISA-A),Achilles tendon total rupture score(ATRS),and Leppilahti score were recorded before surgery,at 3 months postoperatively,at 6 months postoperatively,and at the last follow-up.The Arner-Lindholm score was used to evaluate the efficacy at the last follow-up.The Fowler-Philipp angle(FPA),X/Y ratio,and parallel pitch lines(PPL)were measured before surgery,at 3 months postoperatively,at 6 months postoperatively,and at the last follow-up to evaluate the radiographic results.Results All 40 patients were followed up for an average of(16.87±2.78)months(range:12-24 months).All patients successfully underwent surgery without complications such as nerve or vascular injury.Compared with preoperative scores,the AOFAS score,ATRS score,Leppilahti score,and VISA-A scores increased significantly at 3 months postoperatively,6 months postoperatively,and at the last follow-up,with statistically significant differences(P<0.05).According to the Arner-Lindholm score,the clinical results were rated as excellent in 36 feet and good in 4 feet,with an excellent and good rate of 100%.All incisions healed well,and ankle dorsiflexion and plantarflexion function were normal.In terms of radiographic results,compared with preoperative measurements,the FPA

关 键 词：急性跟腱断裂 踇长屈肌腱转位术 Haglund综合征 

分 类 号：R687[医药卫生—骨科学]