自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱的療效觀察_《中國修復重建外科雜志》

作者：

齊進 , 夏亞一 , 汪玉良 , 趙琳 , 姚長江

蘭州大學第二醫院骨科（蘭州，730030）;

關鍵詞：

跟腱缺損腘繩肌腱（足母）長屈肌腱跟腱重建

DOI：

10.7507/1002-1892.20130263

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱的臨床療效。方法2009年2月－2011年10月，采用自體腘繩肌腱聯合（足母）長屈肌腱轉移重建9例9足跟腱缺損。男6例，女3例；年齡21～65歲，平均43歲。其中運動傷導致陳舊性跟腱斷裂伴缺損5例；跟腱病變切除后跟腱缺損4例，其中跟腱纖維玻璃樣變伴壞死2例、跟腱巨細胞瘤1例、跟腱慢性炎癥伴玻璃樣變1例。病程31～387 d，平均137.6 d。跟腱缺損長度為5～18 cm，平均8.6 cm。術后踝關節石膏固定6周后開始功能鍛煉。結果術后2例發生切口裂開、滲液，1例出現脛神經損傷導致的足底疼痛；余患者切口均Ⅰ期愈合，無相關并發癥發生。9例患者均獲隨訪，隨訪時間13～25個月，平均19.7個月。隨訪期間均無重建肌腱斷裂發生。術后1年及末次隨訪時踝關節背伸活動度與術前比較差異無統計學意義（P gt; 0.05），踝關節跖屈活動度均顯著大于術前（P lt; 0.05）。術后1年及末次隨訪時踝關節跖屈、背伸活動度均顯著大于術后3個月（P lt; 0.05），末次隨訪時與術后1年比較差異均無統計學意義（P gt; 0.05）。患者術后美國矯形足踝協會（AOFAS）及簡明健康調查量表（SF-36量表）評分均較術前顯著提高，且末次隨訪時評分顯著高于術后3個月時，差異均有統計學意義（P lt; 0.05）。末次隨訪時，跟腱修復術后臨床療效評分（ATRS）亦顯著高于3個月時，差異有統計學意義（t= —7.982，P=0.000）。結論自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱療效確切。

引用本文： 齊進,夏亞一,汪玉良,趙琳,姚長江. 自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱的療效觀察. 中國修復重建外科雜志, 2013, 27(10): 1202-1205. doi: 10.7507/1002-1892.20130263 復制

1.	16 苗旭東, 吳永平, 陶惠民, 等. 微創切取長屈肌腱重建慢性跟腱斷裂. 中國修復重建外科雜志, 2011, 25(7): 796-799.
2.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3.	Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon Total Rupture Score (ARTS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
4.	Yeoman TF, Brown MJ, Pillai A. Early post-operative results of neglected tendo-Achilles ruputure reconstruction using short flexor hallucis longus tendon transfer: a prospective review. Foot (Edinb), 2012, 22(3): 219-223.
5.	Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int, 2006, 27(11): 952-959.
6.	Den Hartog BD. Surgical strategies: delayed diagnosis or neglected Achilles’ tendon ruptures. Foot Ankle Int, 2008, 29(4): 456-463.
7.	Hahn F, Maiwald C, Horstmann T, et al. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus longus transfer. Chin Biomech (Bristol, Avon), 2008, 23(1): 109-116.
8.	Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg (Br), 1985, 67(3): 432-437.
9.	Hahn F, Meyer P, Maiwald C, et al. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot ankle Int, 2008, 29(8): 794-802.
10.	Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop, 2010, 34(8): 1187-1192.
11.	Richardson DR, Willers J, Cohen BE, et al. Evaluation of the hallux morbidity of single-incison flexor hallucis longus tendon transfer. Foot Ankle Int, 2009, 30(7): 627-630.
12.	Coull R, Flavin R, Stephens MM. Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int, 2003, 24(12): 931-934.
13.	Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med, 1993, 12(4): 723-756.
14.	Lee YS, Min BH, Han KJ, et al. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture. Orthopedics, 2010, 33(5): 329-331.
15.	俞光榮, 龐清江, 余霄, 等. 跟骨結節撕脫骨折的手術治療. 中華骨科雜志, 2013, 33(4): 320-325.
16.	Chappard C, Brunet-Imbault B, Lemineur G, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int, 2005, 16(10): 1193-1202.
17.	Rigby RB, Cottom JM, Vora A. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg, 2013. [Epub ahead of print].

1. 16 苗旭東, 吳永平, 陶惠民, 等. 微創切取長屈肌腱重建慢性跟腱斷裂. 中國修復重建外科雜志, 2011, 25(7): 796-799.
2. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3. Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon Total Rupture Score (ARTS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
4. Yeoman TF, Brown MJ, Pillai A. Early post-operative results of neglected tendo-Achilles ruputure reconstruction using short flexor hallucis longus tendon transfer: a prospective review. Foot (Edinb), 2012, 22(3): 219-223.
5. Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int, 2006, 27(11): 952-959.
6. Den Hartog BD. Surgical strategies: delayed diagnosis or neglected Achilles’ tendon ruptures. Foot Ankle Int, 2008, 29(4): 456-463.
7. Hahn F, Maiwald C, Horstmann T, et al. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus longus transfer. Chin Biomech (Bristol, Avon), 2008, 23(1): 109-116.
8. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg (Br), 1985, 67(3): 432-437.
9. Hahn F, Meyer P, Maiwald C, et al. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot ankle Int, 2008, 29(8): 794-802.
10. Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop, 2010, 34(8): 1187-1192.
11. Richardson DR, Willers J, Cohen BE, et al. Evaluation of the hallux morbidity of single-incison flexor hallucis longus tendon transfer. Foot Ankle Int, 2009, 30(7): 627-630.
12. Coull R, Flavin R, Stephens MM. Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int, 2003, 24(12): 931-934.
13. Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med, 1993, 12(4): 723-756.
14. Lee YS, Min BH, Han KJ, et al. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture. Orthopedics, 2010, 33(5): 329-331.
15. 俞光榮, 龐清江, 余霄, 等. 跟骨結節撕脫骨折的手術治療. 中華骨科雜志, 2013, 33(4): 320-325.
16. Chappard C, Brunet-Imbault B, Lemineur G, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int, 2005, 16(10): 1193-1202.
17. Rigby RB, Cottom JM, Vora A. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg, 2013. [Epub ahead of print].

《中國修復重建外科雜志》

自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱的療效觀察

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國修復重建外科雜志》

自體腘繩肌腱聯合（足母）長屈肌腱轉移重建跟腱的療效觀察

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料