通道辅助微创吻合技术联合踇长屈肌腱转位治疗跟腱止点撕脱的疗效分析  

Effectiveness analysis of channel-assisted minimally invasive repair technique combined with flexor hallucis longus tendon transfer for Achilles tendon sleeve avulsion

作　　者：孔令通 王中鹤 刘浩宇 詹纳智 齐红哲 陈华[1,2] KONG Lingtong;WANG Zhonghe;LIU Haoyu;ZHAN Nazhi;QI Hongzhe;CHEN Hua(Chinese PLA General Hospital Medical School,Beijing,100853,P.R.China;Senior Department of Orthopedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing,100048,P.R.China;Department of Orthopedics,the Ninth Medical Center of Chinese PLA General Hospital,Beijing,100101,P.R.China)

机构地区：[1]中国人民解放军医学院,北京100853 [2]中国人民解放军总医院第四医学中心骨科医学部,北京100048 [3]中国人民解放军总医院第九医学中心骨科,北京100101

出　　处：《中国修复重建外科杂志》2025年第3期264-270,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：解放军总医院企事业单位合作课题-骨科类医疗器械产品临床前相关研究(YQCH201601)。

摘　　要：目的观察通道辅助微创吻合(channel-assisted minimally invasive repair,CAMIR)技术联合踇长屈肌腱转位治疗跟腱止点撕脱的疗效。方法回顾分析2019年1月—2023年1月采用CAMIR技术联合踇长屈肌腱转位治疗的17例跟腱止点撕脱患者临床资料。其中男13例,女4例;年龄32~65岁,平均49.7岁。致伤原因:运动伤15例,撞击伤2例。受伤至手术时间4~368 d,中位时间15 d。17例患者均存在跟腱止点钙化,其中7例合并Haglund畸形。术后观察患者并发症发生情况,复查MRI评估跟腱愈合情况,术前及末次随访时使用疼痛视觉模拟评分(VAS)、Tegner活动水平分级量表、踝关节活动评分(AAS)、美国矫形足踝协会(AOFAS)踝-后足评分、Victorian运动学院肌腱研究组评分(VISA-A)和主观临床评分评估患者临床疗效。结果手术时间50~62 min,平均56 min;术中出血量5~50 mL,平均19.7 mL。所有患者均获随访,随访时间12~67个月,平均38个月。术后均无跟腱再次断裂、切口感染、下肢深静脉血栓形成、提踵无力、腓肠神经损伤等并发症发生。末次随访时复查MRI示跟腱均愈合良好;VAS评分、Tegner活动水平分级量表、AAS评分、AOFAS踝-后足评分、VISA-A评分均较术前显著改善,差异有统计学意义(P<0.05);末次随访时临床主观评分为6~10分,中位数为9分。结论CAMIR技术联合踇长屈肌腱转位是修复跟腱止点撕脱一种预后较好的治疗方案,患者术后踝关节功能恢复良好,并发症少。Objective To evaluate the effectiveness of the channel-assisted minimally invasive repair(CAMIR)technique combined with flexor hallucis longus(FHL)tendon transfer in the treatment of Achilles tendon sleeve avulsion.Methods A retrospective analysis was conducted on 17 patients with Achilles tendon sleeve avulsion who underwent CAMIR technique combined with FHL transfer between January 2019 and January 2023.The cohort comprised 13 males and 4 females,aged 32 to 65 years(mean,49.7 years).Etiologies included sports-related injuries in 15 cases and blunt trauma in 2 cases.The interval from injury to surgery ranged from 4 to 368 days(median,15 days).All patients exhibited calcification at the Achilles tendon insertion site,with 7 cases complicated by Haglund deformity.Postoperative complications were meticulously monitored,and tendon healing was assessed via MRI.Clinical outcome were evaluated using the visual analogue scale(VAS)score for pain,Tegner activity level rating scale,ankle activity score(AAS),American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,Victorian Institute of Sport Assessment-Achilles(VISA-A)score,and subjective clinical scoring systems preoperatively and at last follow-up.Results The operation time was 50-62 minutes(mean,56 minutes),and the intraoperative blood loss was 5-50 mL(mean,19.7 mL).All patients were followed up 12-67 months(mean,38 months).No postoperative complication,such as Achilles tendon rerupture,incision infection,deep vein thrombosis,heel raise insufficiency,or sural nerve injury,was observed.At last follow-up,MRI examination confirmed satisfactory tendon healing in all cases.Significant improvements were noted in VAS scores,Tegner activity level rating scale,AAS scores,AOFAS ankle-hindfoot scores,and VISA-A scores compared to preoperative ones(P<0.05).At last follow-up,the subjective clinical score ranged from 6 to 10(median,9).Conclusion The CAMIR technique combined with FHL tendon transfer is a good treatment for repair of Achilles tendon sleeve avulsion,with good

关 键 词：跟腱断裂 跟腱止点撕脱 带线锚钉 跟骨骨道 通道辅助微创吻合 踇长屈肌腱转位 

分 类 号：R687.2[医药卫生—骨科学]