摘要
目的总结跟腱再断裂的原因，探讨“V—Y”推进瓣及坶长屈肌腱（flexor hallucis longus，FHL）转位修复重建跟腱再断裂的适应证、疗效及其相关并发症。方法2006年3月至2010年1月手术修复重建跟腱再断裂患者16例16足，男12例，女4例；年龄35-72岁，平均50．9岁。再断裂距初次手术时间为6-49周（平均21．8周），随访时间6-52个月（平均27．5个月）。充分清除断端瘢痕及坏死组织4例断端缺损〈4cm者采用腓肠肌腱膜“V—Y”推进瓣修补，12例断端缺损〉4cm者采用FHL转位修复重建。结合患者病史、康复方式及再次手术术中所见跟腱形态，分析其发生再断裂原因。观察术后局部外观及功能恢复情况，并采用美国足踝外科协会踝一后足评分（American Orthopaedic Foot ＆ Ankle Society-ankle and hindfoot score, AOFAS-AH）及Leppilahti跟腱修复评分进行疗效评价。结果跟腱再断裂的原因主要为手术切口感染、术后跟腱愈合不良发生液化坏死、术后过早负重或活动不当致跌倒。采用“V—Y”推进瓣或FHL转位修复跟腱再断裂术后局部外观及功能恢复良好，AOFAS．AH评分从术前（70．2±8．5）分提高到（92．4±6．1）分；Leppilahti跟腱修复评分从术前（74．8±6．2）分提高到（91．7±4．8）分。踝部MRI显示跟腱部信号均匀，无撕裂或积液表现。结论跟腱再断裂后需彻底清创，导致大范围缺损。腓肠肌腱膜“V—Y”推进瓣可修复〈4cm的缺损，FHL转位可修复重建〉4cm的缺损，术后踝足部功能外形恢复良好。
Objective Recurrent rupture of Achilles tendon is a severe complication after primary repair. The optimal treatment remains controversial. This study was in aiming to explore the risk factors of recurrent ruptures of Achilles tendon, to evaluate the indication, outcome and complications of reconstructing Achilles tendon recurrent ruptures by V-Y advancement flap and Flexor Hallucis Longus tendon （FHL） transfer. Methods We retrospectively studied 16 cases who underwent reconstruction of Achilles tendon re- current ruptures from Mar, 2006 to Jan, 2010. Among them there were 12 males and 4 females with the mean age of 50.9 years （35-72 years）. The period of time between recurrent rupture and primary operation was 6-49 weeks（ave. 21.8 weeks）. The follow-up interval was 6-52 months （ave. 27.5 months）. During operatin, 4 cases with a rupture gap less than 4 cm had received V-Y advancement flap and 12 cases with a rupture gap more than 4 cm had received FHL transfer. At the time of follow-up, all patients were assessed with the American Orthopaedic Foot and Ankle Society （AOFAS） Ankle-Hindfoot Scale and Leppilahti Achilles Tendon Repair score. Results The average AOFAS score had increased from 70.2±8.5 preoperatively to 92.4±6.1postoperatvely. Leppilahti Achilles Tendon Repair score had increased from 74.8±6.2 preoperatively to 91.7±4.8 postoperatvely. MRI of Achilles tendon showed even signal without signs of tear. Conclusion V-Y advancement flap could repair a rupture gap within 4 cm, FHL transfer is suitable for rupture gap over 4 cm in reconstruction of Achilles tendon recurrent ruptures.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第12期1325-1330,共6页
Chinese Journal of Orthopaedics
关键词
跟腱
腱转移术
治疗结果
Achilles Tendon
Tendon transfer
Treatment outcome
