同种异体半腱肌重建慢性跟腱断裂巨大缺损  

Allogeneic semitendinosus tendon for reconstruction of large defects in chronic Achilles tendon ruptures

作　　者：谢飞彬[1] 杨镔[1] 吕靖尧 林臻 XIE Feibin;YANG Bin;LV Jingyao;LIN Zhen(Department of Orthopedic Trauma,Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,China;不详)

机构地区：[1]厦门大学附属中山医院创伤骨科,福建厦门361004 [2]厦门大学医学院,福建厦门361102 [3]福建医科大学附属闽东医院创伤骨科,福建宁德355099

出　　处：《中国骨与关节损伤杂志》2024年第12期1282-1286,共5页Chinese Journal of Bone and Joint Injury

基　　金：厦门市科技计划(医疗卫生项目)(3502Z20184034)。

摘　　要：目的 观察同种异体半腱肌重建慢性跟腱断裂巨大缺损的有效性。方法 回顾性分析2017-07—2022-08采用同种异体半腱肌重建的11例Myerson 3型慢性跟腱断裂巨大缺损,术中显露跟腱后可见断端之间充满瘢痕组织,彻底清创纤维瘢痕及退变组织,直至两边断端为新鲜的跟腱组织,将足踝部置于中立位测量缺损长度,选择合适长度的同种异体半腱肌修补缺损,较大缺损(8~10 cm)选择两根异体半腱肌。结果 11例均获得随访,随访时间12~48个月,平均24.9个月。所有患者均无切口感染、跟腱再断裂、下肢深静脉血栓形成、腓肠神经损伤及血管损伤,1例出现活动性轻度疼痛。术后3~5个月随访时,10例可单足提踵,1例轻度受限。术后3个月MRI T2相仍可见高信号,考虑剩余腱腔填充为肉芽组织,尚未形成成熟的纤维组织。术后6个月MRI显示高信号明显减少,证实跟腱愈合良好,连续性恢复。术前踝与后足功能AOFAS评分为45~79分,平均64.3分;术后12个月踝与后足功能AOFAS评分85~100分,平均95.5分。结论 采用同种异体半腱肌重建跟腱巨大缺损是一种可行的办法,具有手术切口小、对健康跟腱组织干扰少的优点。Objective To evaluate the efficacy of allogeneic semitendinosus tendon reconstruction for chronic Achilles tendon rupture with large defects.Methods A retrospective study of 11 cases of Myerson type 3 chronic Achilles tendon ruptures with large defects managed by allogeneic semitendinosus tendon reconstruction from July 2017 to August 2022 was conducted.Intraoperatively,it was observed that the Achilles tendon ends were separated by scar tissue.A comprehensive debridement was executed to excise the fibrous scar and degenerated tissue,exposing fresh Achilles tendon ends.The defect size was measured with the ankle in a neutral position,and an appropriately sized allogeneic semitendinosus tendon was chosen for the reconstruction.For larger defects(8 to 10 cm),a combination of two allogeneic semitendinosus tendons was utilized.Results All 11 cases were subjected to follow-up for 12 to 48 months,averaging 24.9 months.None of the patients encountered infections,recurrent ruptures of the Achilles tendon,deep venous thrombosis in the lower extremities,sural nerve damage,or vascular injuries,with the exception of a single case reporting mild active pain.During the 3 to 5 month follow-up period,10 cases successfully demonstrated the ability to perform single-leg heel raises,while 1 case exhibited mild limitation.Three months after surgery,MRI T2 sequences showed a persisting high signal intensity,indicating granulation tissue occupying the residual tendon space,suggesting that fibrous tissue had yet to mature fully.By the six-month after surgery,MRI scans depicted a notable reduction in high signal intensity,reflecting proper healing of the Achilles tendon and restoration of its continuity.Preoperative AOFAS AnkleHindfoot scores was 45 to 79,with an average of 64.3;postoperative AOFAS Ankle-Hindfoot scores at 12 months was 85 to 100,with an average of 95.5.Conclusion The reconstruction of large Achilles tendon defects using allogeneic semitendinosus tendons is a viable and effective surgical method.This technique enables t

关 键 词：慢性跟腱断裂 同种异体半腱肌腱 重建 

分 类 号：R686.1[医药卫生—骨科学]