吻合膝降血管大收肌腱游离移植复跟腱缺损

目的 报道吻合膝降血管大收肌腱移植修复跟腱缺损新的方法及临床效果。方法 在４２侧下肢标本解剖观测了大收肌腱形态和血供来源、血管走行、分支和分布情况，设计了吻合膝降血管的大收肌腱游离移植修复跟腱缺损的术式。结果 临床应用８例，全部病例随访２～８个月，临床近期效果满意。结论 吻合管大收肌腱游离移植修复跟腱缺损具有术式简单，再造跟腱外形近似正常，受区损伤小等优点，是跟腱缺损修复一个良好的供区。     

应用吻合血管的游离肌腱瓣修复陈旧性跟腱缺损

目的 探讨股直肌联合股外侧肌肌腱瓣移植修复陈旧性跟腱缺损的临床疗效.方法 应用旋股外侧动脉降支肌穿支或肌间隙穿支为血供,切取股直肌联合股外侧肌腱瓣行吻合血管移植,修复陈旧性跟腱断裂伴肌腱缺损5例.切取肌腱瓣7cm×3cm～ 15cm×3 cm.与胫后动、静脉穿支血管吻合修复.结果 术后创口一期愈合.术后随访9～40个月,踝关节屈伸功能良好.小腿三头肌肌力均恢复Ⅳ级以上,提踵试验阴性.供区愈合满意,股四头肌肌力正常.结论 股直肌、股外侧肌肌腱瓣具有血供丰富、血管解剖容易、肌腱强度好的优点,股直肌联合股外侧肌肌腱瓣移植是修复陈旧性跟腱断裂伴肌腱缺损的有效方法之一.     

跟腱缺损的分类和手术治疗

目的探讨跟腱缺损的分类及手术方式的选择。方法对1994年7月～2004年1月间56例跟腱缺损患者的手术治疗和随访资料进行回顾分析,根据跟腱组织缺损情况及缺损长度分为三类9型,其中采用跟腱端端吻合法16例,Lindholm’s法14例,吻合血管大收肌肌腱(皮瓣)移植18例,吻合血管髂胫束(皮瓣)移植6例,吻合血管腓骨、吻合血管大收肌肌腱骨皮瓣联合移植1例,吻合血管背阔肌腱膜皮瓣移植1例。结果56例随访1年6个月～8年3个月,平均5.3年,按Thermanns功能评定:优35例,良12例,可8例,差1例,优良率83.9%。结论鉴于跟腱缺损的伤情复杂,临床分类、分型有利于外科手术方式的选择。跟腱缺损采用显微外科修复方法,跟腱局部损伤小,有利于修复跟腱尽快愈合,抗张力性能好,早期功能练习,是符合跟腱解剖和生理功能重建需求的良好选择。     

跟腱缺损显微外科修复的远期疗效

目的 探讨跟腱缺损显微外科治疗手术方式的选择及其远期疗效。方法 自1999年1月至2003年7月间，对26例跟腱缺损患者进行显微外科手术治疗，根据跟腱缺损长度及组织缺损情况分为三类9型，其中吻合血管大收肌肌腱（皮瓣）移植18例，吻合血管髂胫束（皮瓣）移植6例，吻合血管腓骨、吻合血管大收肌肌腱-骨-皮瓣联合移植1例，吻合血管背阔肌腱膜皮瓣移植1例。结果 临床应用26例，皮瓣全部成活，随访2～6．5年，平均4．3年，按Thermann’s功能评定：优18例，良6例，可1例，差1例，优良率92．3％。结论 跟腱缺损的伤惰复杂，临床分类、分型有利于显微外科手术方式的选择；跟腱缺损采用显微外科修复方法是符合跟腱解剖和生理功能重建需求的良好选择。     

吻合血管髂胫束移植修复跟腱缺损

目的探讨带血管的髂胫束游离移植修复跟腱缺损的术式及疗效. 方法在解剖观测髂胫束的血供来源及膝上外侧动脉的起源、走行、分支、分布及吻合的基础上,进行手术设计.1999年9月～2003年1月应用吻合血管的髂胫束修复长段跟腱缺损6例,其中单纯跟腱缺损4例,复合跟腱缺损2例,缺损长度6～11 cm. 结果膝上外侧动脉起自动脉,向外上走行分为升、降支.升支发出肌支和髂胫束穿支;膝上外侧动脉升支与膝最上外侧动脉在股外侧肌内吻合后穿出股外侧肌形成肌皮穿支.降支发出肌支、3～5支股骨外侧髁骨膜支及髂胫束穿支.术后供、受区创面均一期愈合.随访6个月～3年8个月个月,Thompson征阴性,双、单足提踵试验阴性.无跟腱再断裂、跟区皮肤破溃等并发症发生. 结论根据膝上外侧血管的分支、分布及吻合特点,吻合血管的髂胫束游离移植是修复跟腱缺损的一种较好的治疗方法.     

膝降血管为蒂组织瓣治疗濒临截肢二例

例１男，４０岁。８个月前右足跟被电梯挤伤，因骨髓炎，皮肤坏死入我院治疗。检查见：右足跟后大部缺损 １０ ｃｍ×５ ｃｍ，跟腱部分缺损。Ｘ线片示：跟骨结节内缘斜向跟骨底中部以后缺损。术前７ｄ局部消毒液浸泡，抗炎。术中彻底清除感染和坏死病灶，利用髂骨板重叠修形后，修复跟骨底外后缘。游离吻合股降血管关节支为蒂带内收肌结节，肌腱的股骨内侧髁骨膜（骨）瓣，修复重建跟后结节和跟腱。用隐血管隐神经皮瓣（１２ｃｍ × １０ ｃｍ）交腿移植修复跟骨后皮缺损。术中皮瓣隐神经与受区隐神经吻合。术后２个月移植骨愈合，皮瓣成活…     

游离移植内收大肌骨皮瓣修复跟腱复合组织缺损

跟腱损伤是较常见的损伤,修复时由于跟部皮肤软组织紧张度高,局部水肿致切口缝合困难,如合并跟骨及皮肤的缺损,修复更困难,这类损伤一直是创伤外科棘手的难题.本院于2004年2月～2008年9月采用吻合血管内收大肌肌腱骨皮瓣联合移植对9例跟腱复合组织伤进行修复,疗效满意.     

吻合血管的足背复合组织瓣修复前臂手背复合伤

我院于１９８８年至今，采用吻合血管的足背肌腱皮瓣，一期修复前臂及手背皮肤、肌腱缺损５例。复合组织瓣全部成活，创面１期愈合，功能恢复较为满意。一、资料与方法一般资料：本组５例，男４例，女１例。年龄１７～３５岁。损伤部位：手背皮肤、肌腱撕脱伤４例，其中２～５指指伸肌腱缺损２例，示、中指指伸肌腱缺损２例，肌腱近端均在Ⅲ区。前臂下端皮肤缺损，合并肌腱、部分桡骨缺损１例，肌腱近端在Ⅰ区。手术方法：５例患者，彻底清创后采用游离足背复合组织瓣移植，修复创面及肌腱、骨头。皮瓣面积为６ｃｍ×８ｃｍ～１０ｃｍ×１２…     

足底内侧穿支皮瓣修复足跟部创面的临床应用

目的探讨带蒂足底内侧穿支皮瓣应用于跟腱损伤合并皮肤软组织缺损修复的效果。方法对跟腱损伤合并表面皮肤软组织复合性缺损患者18例,缺损面积为4.0 cm×2.0 cm～10.0 cm×5.0 cm,均采用带蒂足底内侧穿支皮瓣转移修复跟腱表面皮肤软组织缺损。其中12例跟腱断裂未合并明显缺损,采用传统的修复方法直接缝合固定;6例合并跟腱缺损(长度为3.0～8.0 cm),采用腓骨短肌肌腱转位(4例)和腓骨短肌肌腱转位合并腓肠肌肌腱翻转加固重建(2例)。评估缺损情况、手术成功率、并发症情况以及随访外观功能情况。结果所有患者获随访10～42个月(平均18.5个月),供、受区创面均一期愈合;单足提踵试验呈阴性,无跟腱再次断裂;皮瓣无溃破、感染等并发症。按Thermann功能评定标准:优8例,良6例;优良率为77.8%。结论采用带蒂足底内侧穿支皮瓣转移修复跟腱损伤合并周围皮肤软组织缺损,其皮瓣质地较好,厚度适中,且耐磨耐压,是修复跟腱部皮肤缺损较理想的方法之一。     

背阔肌肌皮瓣移植急诊修复肢体软组织缺损

１９９１年４月～１９９４年８月，急诊治疗１０例肢体大面积损伤伴骨骨各、肌腱裸露患者，采用带血管蒂背阔肌肌皮瓣移位修复１例，游离背阔肌肌皮瓣移植修复６例，游离双侧背阔肌肌皮瓣组合移植修复３例。移植肌皮瓣完全成活６例，远端皮肤部分坏死３例，大部分皮肤坏死１例，但肌瓣均全部成活。有２例发生轻微感染，换药后愈合。介绍了手术方法，讨论了手术适应证及急诊修复创面的优点等。     

Vascularized transfer of the adductor magnus tendon and its osseous insertion: a preliminary report

The adductor magnus tendon and its insertion (cortical and cancellous bone) are vascularized by the articular branch of the descending genicular artery of the knee. Anatomic findings support a reliable transfer of vascularized bone or tendon. Some applications are restoration of the cruciate ligament of the knee, free vascularized bone transfer for treatment of avascular bone necrosis or post-traumatic pseudoarthrosis, and pedicled tendon transfer to reinforce repairs of the medial ligament of the knee.     

腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损

作者自行设计使用腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损48例,获得完整随访资料43例。跟腱缺损长度为8～10cm,自身已无修复条件。手术方法的优点:联合转移的肌腱弥补了长距离跟腱缺损,保持了原有肌肉的动力,弥补了小腿三头肌的挛缩无力。保持了足内、外翻的肌力平衡,足外形正常。肌肉的血循环不受干扰,增加了修复跟腱后愈合的机会。手术后6周都能逐渐下地行走,肌力一般都能达到Ⅳ级～V级,功能恢复良好,未发生因愈合不良再次发生断裂。     

One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment

The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata. The size of the ALT flaps ranged from 10 to 16 cm in length and 6 to 9 cm in width. All flaps included vascularized fascia lata, which was rolled to serve as vascularized tendon graft (range 8 x 6 cm to 10 x 8 cm) for reconstruction of the Achilles tendon defect. Flap success rate was 100%. All patients could walk and climb stairs without support; however, mild difficulty when running was reported. Functional outcome of the recipient ankle and donor thigh morbidity were investigated by using a kinetic dynamometer comparing reconstructed sides with the healthy contralateral limbs. This assessment was performed in two patients at 2 years postoperatively. In the reconstructed ankles, isokinetic concentric measurements of dorsiflexion and plantar flexion showed a deficit of 30% and 40%, respectively. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed a 10% to 25% deficit. However, there were no difficulties in daily ambulating. In summary, the free composite ALT flap with vascularized fascia lata provides an alternative option for Achilles tendon reconstruction in complex defects.     

腓肠肌内侧头肌腱前移重建髌韧带的解剖及临床应用

目的 报道腓肠肌内侧头肌腱前移重建髌韧带缺损新的修复方法 . 方法 通过对30侧下肢标本解剖观测腓肠肌内侧头肌腱的形态和血供来源,设计了以腓肠内侧头血管供血带肌蒂的腓肠肌内侧头肌腱前移重建髌腱缺损的术式.临床应用4例. 结果 全部病例随访2～8个月.膝关节伸直功能恢复满意,无再断裂并发症.1例因膝关节骨缺损伸直170°,屈曲120°,有轻度跛行. 结论 带肌蒂的腓肠肌内侧头肌腱前移重建髌腱缺损有术式简单、再造髌腱外形结构接近正常、受区损伤小等优点.腓肠肌内侧头肌腱前移为髌腱缺损修复提供了一种良好的方法 .     

Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata

Segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a complex reconstructive challenge. Successful reconstruction combines tendon repair with coverage of the defect by soft tissue flaps, creating an entity that meets up to three predetermined goals: (1) approaching preinjury functionality, (2) resisting shearing forces, and (3) achieving an esthetic result. From June 2009 to June 2011, our center submitted six patients to a one-stage procedure correcting the Achilles tendon using a composite free anterolateral thigh (ALT) flap with vascularized fascia lata. The flap sizes ranged from 5 to 8 cm in width and 16 to 20 cm in length and all flaps included vascularized fascia lata which was rolled to serve as an Achilles tendon. After reconstruction our patients showed good functional results, these patients could walk, climb stairs, and tiptoe again without support. Moreover, normal footwear could be worn. A free composite ALT flap with vascularized fascia lata is a reliable option for coverage of Achilles tendon and overlying soft tissue defects, even in elderly patients.     

跟腱伴皮肤缺损的一期腓肠肌肌皮瓣修复

目的介绍腓肠肌推进皮瓣一期修复跟腱伴腱周皮肤缺损的方法。方法对8例跟腱伴腱周皮肤缺损,采用双蒂腓肠肌皮瓣V-Y推进下移修复。结果随访4个月～6年。8例缺损均一期愈合。患肢均恢复行走能力。膝踝功能满意。结论双蒂腓肠肌皮瓣V-Y推进下移可一期修复跟腱伴腱周皮肤缺损。     

Bilateral Cadaveric Achilles Tendon Graft in Reconstruction after Achilles Tendon Tumor Resection

The standard approach to reconstruction after resection of a diffuse-type tenosynovial giant cell tumor is a local patch with free flaps. However, in cases in which the Achilles tendon involvement is extensive, and the entire tendon must be removed, an autologous flap graft might not be adequate to allow a return to function. We report a case of a 52-year-old female patient who developed bilateral tumors of the Achilles tendon, with a 10-year duration. By the time, she sought medical help, both Achilles tendons required removal. We chose to use Achilles tendon allografts to replace the Achilles tendons. Postoperatively, the patient did well. The allograft shortened the recovery time, and the patient regained full ankle range of motion.     

Achilles Tendon Reconstruction With Bone Block Allograft:Long-Term Follow-Up of Two Cases

The treatment of neglected or chronically ruptured Achilles tendon is challenging. Various treatments for large defects associated with chronic Achilles ruptures have been described. Many surgeons recommend the use of a tendon transfer, turndown rotational flap, advancement flap, or reconstruction with Achilles tendon allograft with calcaneal bone block. Long-term outcomes of these procedures are unknown. We present 2 cases with the use of an Achilles tendon with calcaneus bone block allograft. At >8-year follow-up duration, both patients are afforded satisfactory levels of activity and are without pain or gait disturbance. This procedure is a viable option for Achilles ruptures with large defects, ruptures with small intact distal tendon portions, or re-ruptures of previously repaired Achilles tendons. The long-term outcomes of these case reports suggest that Achilles tendon reconstruction with bone block allograft is a viable option.     

62例跟腱断裂修复手术远期疗效观察

目的 探讨手术修复跟腱断裂的临床效果和影响预后因素。方法 对１９６１～１９９４年８０例采用手术治疗的跟腿断裂中的６２例临床资料进行了分析,其中采用“８”字缝合法８例,两条腱膜瓣下翻修复３０例,腓骨长肌移位修复２例,倒“Ｖ－Ｙ”形腱成形术１０例,对端褥式缝合１２例。结果 ６２例随访３～３３年,按尹庆水评分标准,优４０例,良１３例,可６例,差３例,优良率为８５．５％。术后感染和再断裂各６例,各占总数的