腓骨肌腱滑脱症的手术治疗(附4例报道)

目的探讨腓骨肌腱滑脱症的手术治疗方法及临床疗效分析。方法自2008年10月~2015年6月,手术治疗腓骨肌腱滑脱症患者4例,其中1例采用改良Watson-Jones术,3例采用带线锚钉修复腓骨肌上支持带。结果4例均获得随访,随访时间10~16个月,平均12个月,末次随访时参照Mazur等制定的踝关节症状与功能评分系统,优3例,良1例,优良率100%。无感染、皮肤坏死、再脱位等并发症发生。结论改良Watson-Jones术及带线锚钉方法操作简单、能有效治疗腓骨肌腱滑脱症,远期疗效有待进一步观察。     

跟腱条结合带线铆钉重建腓骨肌支持带治疗腓骨肌腱滑脱症

目的探讨跟腱条结合带线铆钉重建腓骨肌支持带治疗慢性腓骨肌腱滑脱症的临床疗效。方法回顾性分析2010年1月至2015年1月我科7例采用跟腱条结合带线铆钉重建腓骨肌支持带治疗慢性腓骨肌腱滑脱症的患者资料,记录术前及术后踝关节活动度,并采用美国矫形足踝协会(AOFAS)踝与后足主观评分标准评定踝关节功能。结果 7例患者均获术后随访6~24个月,平均随访14个月,所有病例术后均未复发。踝关节活动度从术前的(23.6±1.9)°恢复到末次随访的(30.0±1.5)°,AOFAS评分从术前的(60.6±3.6)分恢复至末次随访时的(93.6±3.9)分。结论采用跟腱条结合带线铆钉重建腓骨肌支持带治疗慢性腓骨肌腱滑脱症具有良好的临床疗效,是手术治疗慢性腓骨肌腱滑脱症的有效方法之一。     

部分胫骨后肌腱与腓骨长肌腱合并一例

在标本修整中发现一右侧足,胫骨后肌腱经内踝后面的沟内,单独穿过骨性纤维管至足底内侧缘。胫骨后肌腱中占三分之一略强的纤维与腓骨长肌腱在距其止点1cm处会合（见照片）。会合后共同至腓骨长肌腱的止点。其余胫骨后肌腱的腱纤维止点同正常人体。即一部分腱纤维止于舟骨粗隆,一部分腱纤维止于第一、二、三楔骨。腓骨长肌腱在足底经过骰骨跖侧面的腓骨长肌腱沟（该沟被跖长韧带所遮被）,在跖长韧带的内侧缘,腓骨长肌腱与胫骨后肌部分腱纤维会合。会合后即开始有止点纤维附着于第一楔骨和第一跖骨基底部的跖侧面的外侧。1．第1跖骨粗隆2…     

腓骨长肌腱复合骨形态发生蛋白重建前交叉韧带的临床研究

目的比较分析应用腓骨长肌腱复合骨形态发生蛋白与单纯腓骨长肌腱重建前交叉韧带术后的临床疗效。方法回顾2006年8月~2008年12月,采用腓骨长肌腱复合骨形态发生蛋白重建ACL18例,男14例,女4例,年龄21~47岁,平均35.5岁。采用单纯腓骨长肌腱重建ACL24例,男18例,女6例,年龄25~50岁,平均37.6岁。术后观察并记录症状、体征变化,并行体格检查、膝关节Lysholm评分、KT-1000检测,并在CT片上测量胫骨、股骨隧道的直径。采用t检验比较两组间差异。结果 18例采用腓骨长肌腱复合骨形态发生蛋白重建及24例采用单纯腓骨长肌腱重建的患者平均随访14个月和16个月。两组在住院与发热天数、手术时间、关节引流量上无显著性差异(0.05)。单纯腓骨长肌腱重建组出现了3例Lachman征阳性体征,而腓骨长肌腱复合骨形态发生蛋白重建组无一例出现Lachman征阳性。两组随访时的Lysholm评分分别为(92.4±3.7)分和(89.3±4.5)分,两组间差异有显著性(0.05)。腓骨长肌腱复合骨形态发生蛋白组无一例出现骨隧道扩大,而单纯腓骨长肌腱组有4例(4膝)出现了骨隧道扩大。结论腓骨长肌腱复合骨形态发生蛋白重建ACL的方法优于单纯腓骨长肌腱重建法。     

腱间筋膜与伸指肌腱滑脱

伸指肌腱滑脱治疗中,仅修复肌帽及矢状束的损伤,其结果常不理想。1997年与2001年,我们于11例伸指肌腱滑脱修复手术中,重视腱间筋膜的修复,术后无一例复发。 一、资料与方法 1.临床资料:本组共11例(指),男9例,女2例;年龄21～54岁;致伤原因:弹指击物7例,打救受伤4例。中指7例,环指3     

可吸收性防粘连膜在肌腱修复中的临床研究

目的 观察可吸收性防粘连膜预防肌腱修复术后粘连的临床应用效果。方法 将42例急性手部屈伸肌腱损伤患者分为两组，试验组用DL-乳酸可吸收性防粘连膜包绕肌腱缝合端，对照组不使用可吸收性防粘连膜，对损伤肌腱均采用5-0肌腱缝线行Kessler改良法修复，所有病例术后均行石膏托外固定。鼓励患者早期做手指活动，三周后拆除石膏托，行主动性手指屈伸锻炼。结果 术后随访时间2～10个月，平均4．6月。屈肌腱修复后的功能用TAM系统评定法评定，伸肌腱功能恢复用Miller分级法评定。试验组综合优良率为96．08％(49／51)，对照组综合优良率为51．11％(23／45)。结论 可吸收性防粘连膜临床使用时操作简单、方便，能够有效减轻肌腱吻合术后粘连形成，具有良好的临床应用前景。     

可吸收性防粘连膜在肌腱修复中的临床研究

目的观察可吸收性防粘连膜预防肌腱修复术后粘连的临床应用效果.方法将42例急性手部屈伸肌腱损伤患者分为两组,试验组用DL-乳酸可吸收性防粘连膜包绕肌腱缝合端,对照组不使用可吸收性防粘连膜,对损伤肌腱均采用5-0肌腱缝线行Kessler改良法修复,所有病例术后均行石膏托外固定.鼓励患者早期做手指活动,三周后拆除石膏托,行主动性手指屈伸锻炼.结果术后随访时间2～10个月,平均4.6月.屈肌腱修复后的功能用TAM系统评定法评定,伸肌腱功能恢复用Miller分级法评定.试验组综合优良率为96.08%(49/51),对照组综合优良率为51.11%(23/45).结论可吸收性防粘连膜临床使用时操作简单、方便,能够有效减轻肌腱吻合术后粘连形成,具有良好的临床应用前景.     

习惯性腓骨肌腱滑脱的手术治疗

腓骨肌腱滑脱并非罕见的损伤.但在临床早期往往因外踝局部的肿胀、疼痛,活动受限,及临床医生往往偏重于对骨质的关注却忽视对肌腱受损情况的观察,而延误诊断,以至晚期每当踝关节背伸活动时,腓骨肌腱即滑向外踝前方,形成习惯性腓骨肌腱滑脱.本院自1996年2月～2005年1月收治此类病人19例,治疗效果比较满意.总结如下.     

手术加支具辅助功能练习治疗指深屈肌腱Ⅰ区断裂

目的：观察并分析手术加支具辅助功能练习治疗指深屈肌腱Ⅰ区断裂的临床效果。方法回顾分析2010~2013年期间指深屈肌腱Ⅰ区断裂患者12例,均一期手术修复,术后1w开始行支具辅助功能练习,4w拆除支具,6w取出内固定物。结果术后均获得随访,时间3个月~12个月,远侧指间关节主动活动范围平均45o,按Strickland和Glogovac评分标准评定,优2例,良7例,可3例。结论指深屈肌腱Ⅰ区断裂一期手术修复,早期支具辅助下功能练习可获得良好疗效。     

带血管蒂排骨长肌腱转位修复跟腱缺损的临床应用

目的：报道带血管蒂腓骨长肌腱转位修复跟腱缺损的应用解剖、生物学力学和手术方法。：在４０例动脉灌注红色乳胶的成人下肢标本上，对腓骨长肌腱进行显微解剖学观测及生物力学研究。在解剖学研究的基础上，设计并应用带血管腓骨长肌腱及皮瓣转位修复跟腱。结果：采用该术式修复跟腱及皮肤缺损９例。经１０个月￣１．５年随访，移植的肌腱及皮瓣全部成活８例，愈合良好，跟腱功能恢复。１例皮瓣边缘性坏死，经短期换药愈合。结论：带     

Clinical anatomy of the chiasma tendlinum (camper) in the fingers

Sixty human hands from adult cadavers were used to study the chiasma tendinum (Camper) of the flexor digitorum superficialis tendon in the finger. Two hundred forty fingers were microdissected and examined morphometrically. The formation of the chiasma tendinum could be divided into nine types. The most common type shows that the flexor digitorum superficialis tendon divides into four bundles, the two inner of which cross each other. The length and width of the chiasma tendinum in the middle finger is the longest and widest, while in the little finger it is the shortest and narrowest. The relationship of the chiasma tendinum and the long vinculum of the flexor digitorum profundus tendon was also observed in the present study. In the most common type the long vinculum lies distal to the chiasma lying between the two terminal tendons of the flexor digitorum superficialis. The authors suggest three functions for the chiasma tendinum: (1) it provides a pathway for the flexor digitorum profundus tendon; (2) it increases the stability and balance of the proximal interphalangeal joint; and (3) it prevents hyperextension of the proximal interphalangeal joint. © 1994 Wiley-Liss, Inc.     

Tendon impingement of the extensor digiti minimi: clinical cases series and cadaveric study

The authors describe two unique clinical cases of closed extensor digiti minimi (EDM) tendon injuries after hyperflexion of the wrist with full finger flexion and one case of chronic tenosynovitis around the EDM tendon. All three cases were thought to be related to the bifurcation of the EDM tendon and synovial septum. Subsequently, variations in EDM tendons were investigated in 49 cadaveric hands with a focus on patterns of tendon bifurcation and their relationships with the surrounding synovial sheath. The EDM tendon was found to be bifurcated in 74% (n = 36) of hands and all of these hands contained a synovial septum. In 9 (25%) hands, the EDM tendon bifurcated proximal to the retinaculum, in 15 (42%), it bifurcated distal to the retinaculum, and in the other 12 hands (33%), the tendon bifurcated at the retinacular level. In 6 of the 15 hands with an infraretinacular bifurcation, the tendon was found to impinge on the synovial septum during passive flexion of the wrist with full finger flexion, and the mean distance between the synovial septum and the bifurcation point in these specimens was 0.6 cm (range, 0.4-0.7 cm), which was differed significantly from hands not showing impingement (P = 0.01). This study shows that distal bifurcation of the EDM tendon may lead to tendon impingement on the septum and suggests that this is a potential etiology of chronic tenosynovitis of the fifth compartment and of acute closed tendon injuries.     

小腿有关肌腱转位修复跟腱的生物力学评价

目的：为临床选用自体肌腱转位修复跟腱提供生物力学依据。方法：选用防腐固定成年和新鲜青年下肢各７例。制备拉伸试件，在ＳＷＤ－１０型材料试验机上，进行单向拉伸破坏实验。结果：跟腱、腓骨长肌腱、腓骨短肌腱、胫骨后肌腱及展肌腱固定组分别为２２９２．６Ｎ、１０２０．５Ｎ、７５２．０Ｎ、９３８．９Ｎ和７２１．３Ｎ，新鲜组分别为１９２７．１Ｎ、８１９．５Ｎ、３４６．７Ｎ、６９９．７Ｎ、３０３．８Ｎ。结论：腓骨长肌腱是跟腱缺损修复术较理想的自体材料。     

带血管蒂肌腱移植修复跟腱缺损的实验研究

目的为带血供肌腱移植修复跟腱缺损提供生物力学和组织学依据.方法选用新西兰大白兔15只,其中12只分两组一侧行带血管蒂趾长屈肌腱转位修复跟腱缺损,对侧为游离肌腱移植对照组,术后12周取材,分别行组织学检查和生物力学测试.结果带血管蒂肌腱组移植跟腱组织学形态近似正常跟腱,肌腱最大拉伸力为正常跟腱的67.7%,而游离肌腱组移植跟腱的腱纤维为瘢痕包裹,最大拉伸力为跟腱的35.3%,两者的差异性非常显著(P＜0.01).结论带血管蒂肌腱移植修复跟腱缺损优于游离肌腱移植.     

The conjoint junction of the triceps surae: implications for gastrocnemius tendon lengthening

Forty embalmed cadaver lower limbs were dissected to identify the morphology of the conjoint junction of the tendons of gastrocnemius and soleus and the location of the gastrocnemius tendon relative to bony landmarks. Five patterns of conjoint junction morphology were found: transverse (25%), oblique passing distally and medially (45%), oblique passing distally and laterally (5%) and arcuate as an inverted U (17.5%) and a U-shape (7.5%). Left-right asymmetry of the junction was observed in 31.6% of 19 paired cadaver legs. On the medial side of the calf the gastrocnemius tendon could be located between 38 and 46% of the proportion of the distance between the upper border of the calcaneus and the fibular head. Corresponding values for the midline and lateral side of the calf were 45-58% and 48-51%. The location of the gastrocnemius tendon relative to bony landmarks may help to guide incision planning for open or endoscopic division of the tendon.     

同种异体肌腱修复手部肌腱缺损优良率的Meta分析

目的通过Meta分析统计同种异体肌腱用于手部肌腱缺损移植修复优良率。方法检索1966年~2015年间异体肌腱用于手部肌腱缺损移植修复的相关文献,采用循证医学Meta分析对患者手部肌腱移植修复优良率进行综合分析。结果使用随机效应模型计算单组率的Meta分析,同种异体肌腱移植优良率75%(69%~82%)。进一步分层分析,8篇使用手指数为样本量单位的研究移植优良率为75%(66~83%),11篇以病例数为样本量单位的研究移植优良率为76%(68%~85%)。结论同种异体肌腱用于手部肌腱缺损移植的优良率约为75%。     

跟腱复合组织缺损的显微外科修复

目的 :探讨跟腱复合组织缺损的显微外科治疗。方法 :应用膝降血管大收肌腱、骨、皮复合组织瓣移植一期修复跟腱伴皮肤和跟骨缺损。结果 :施术 3侧 ,取得满意效果。结论 :该术式可修复不同类型的跟腱复合组织缺损 ,并具有操作简便、易行和供区损伤小等特点。     

Anatomical study of the plantaris tendon: reliability as a tendo-osseous graft

Purpose  The purpose of this study was to investigate the insertion of the plantaris tendon in terms of shape, length, width and size, to define if there is available bony insertion for future use as reconstructive procedure in secondary tendon graft in hand surgery. Methods  In 30 limbs, the plantaris tendon was anatomically dissected to investigate its bony attachments to the calcaneus. Results  The plantaris was present in 29 of 30 dissections and regularly inserted in the calcaneus. Conclusions  The tendo-osseous plantaris graft is, according to this research, amenable to be used as a viable choice in reconstruction of secondary flexor tendon injuries related to its length shape and size and especially due to the bone stock adequate to strong phalanx fixation.