腓肠肌腱膜瓣翻转修复陈旧性跟腱断裂

自１９９３年６月～１９９８年１月我院共收治跟腱断裂２７例,其中陈旧性断裂者１３例,采用腓肠肌腱膜瓣翻转修复跟腱,局部皮瓣推移覆盖创面的方法治疗,效果满意,总结如下：临床资料一、一般资料本组１３例均为外院首次治疗失败后转入病人。其中男５例,女８例;年龄...     

腓肠肌腱膜皮瓣修复治疗陈旧性跟腱断裂

<正>2005年1月~2013年1月,我科采用腓肠肌腱膜皮瓣翻转修补术治疗26例陈旧性跟腱断裂患者,报道如下。1材料与方法1.1病例资料本组26例,男22例,女4例,年龄18~45岁。患者均有提踵无力及跛行,其中Thompson试验阳性24例。跟腱断裂位置均靠近中段,缺损长3~7 cm。均为陈旧性跟腱断裂,受伤至手术时间5~12周。1.2手术方法连续硬膜外麻醉。跟腱稍偏外侧缘切口入路,显露断裂跟腱及腓肠肌下端。完整切除跟腱坏死瘢痕组织,用可吸收0号爱惜康缝线于断端近侧以上约0.5 cm处水平褥式缝合,从     

改良腓肠肌腱瓣翻转联合抗生素骨水泥技术治疗跟腱术后再断裂感染

目的 探讨改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗跟腱术后再断裂合并感染的初期临床疗效。方法 回顾性分析2015年1月至2018年6月绵阳市中心医院与解放军中部战区总医院合作收治的17例跟腱再断裂合并感染病人,采用彻底清创,改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗,观察病人手术相关指标、术后并发症。记录病人术前及末次随访的美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分系统与疼痛视觉模拟量表（visual analogue scale,VAS）评分。采用踝关节功能Kofoed评分标准评价疗效。结果 17例病人均获得随访,随访时间为（12.8±4.4）个月（8~20个月）。16例病人术后切口获得一期愈合,1例术后伤口边缘皮肤浅表坏死,经过局部换药处理4周后伤口获得二期愈合。1例出现腓肠神经损伤,给予口服甲钴胺治疗后有所缓解。末次随访未观察到感染复发、再断裂、关节僵硬等严重并发症。AOFAS评分由术前（50.15±7.61）分改善至（90.12±5.46）分;VAS评分由术前（5.12±1.65）分减轻至（1.12±0.65）分,差异均有统计学意义（P＜0.05）。按踝关节Kofoed评分标准：优2例,良14例,及格1例。结论 对于跟腱术后再断裂合并感染的病人,采用改良腓肠肌腱瓣翻转联合抗生素骨水泥链珠、负压封闭引流技术治疗,初期临床疗效较好,是一种可行的选择方式。     

改良Lindholm腓肠肌倒转腱膜瓣加强修复急性跟腱断裂

目的探讨治疗急性跟腱断裂的手术方法及疗效。方法对Lindholm腓肠肌倒转腱膜瓣加强修复跟腱断裂术进行改良,修复45例急性跟腱断裂。用Kessler法缝合跟腱断端,改良术中切取大小为0.5 cm×7cm 2条腓肠肌腱膜瓣,预制成腱膜片后倒转包裹修复跟腱缝合端,恢复外形。结果术后无感染、切口坏死、腓肠神经损伤及跟腱再断裂等并发症,跟腱修复处外形良好。患者均获随访,时间12～20个月。术后1年根据Arner-Lindholm评定标准评价治疗效果:优43例,良2例。结论改良Lindholm腓肠肌倒转腱膜瓣是加强修复急性跟腱断裂的有效手术方法。     

跖肌腱扇形膜片和腓肠肌腱瓣V-Y成形术治疗陈旧性跟腱断裂

目的　研究跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗陈旧性跟腱断裂的术式及结果。方法　对 14例平均 89d陈旧性跟腱断裂患者采用跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗 ,跟腱缺损范围为 3 6～ 7 3cm ,平均为 5 2cm ,跟腱缺损范围较大时 (大于 6 5cm) ,可加用跖肌腱加固术。结果　平均随访 2年 4个月 ,按Arner-Lindholm疗效评定标准评估 ,优 11例 (78 6 % ) ,良 2例 (14 3% ) ,优良率为 93%。结论　跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗陈旧性跟腱断裂 ,临床疗效满意 ,值得推广。     

V-Y肌腱瓣修补术治疗陈旧性跟腱断裂

目的 研究V—Y肌腱瓣修补术治疗陈旧性跟腱断裂的手术方法及结果。方法 对9例平均112d的陈旧性跟腱断裂患，采用小腿三头肌V—Y肌腱瓣修补术治疗修补缺损为3．2～6cm，平均4．6cm。结果 平均随访2年8个月，按Arner-Lindholm疗效评定标准评估，优7例(77．8％)，良2例(22．2％)，优良率为100％。结论 对于陈旧性跟腱断裂，小腿三头肌V—Y肌腱瓣修补术足一种方法简单、疗效满意的手术方法。     

拇长屈肌腱移位修复陈旧性跟腱断裂

对于各种原因造成的陈旧性跟腱断裂只有采取手术治疗，其手术方法报道较多，但对拇长屈肌腱移位修复陈旧性跟腱断裂的手术方法，国内报道甚少。2001年11月至2005年5月，我科采用拇长屈肌腱移位修复陈旧性跟腱断裂8例，获得较好的治疗效果，现报告如下。     

改良手术切口腓肠肌腱膜翻转治疗陈旧性跟腱断裂

目的 探讨改良切口腓肠肌腱膜翻转术治疗陈旧性跟腱断裂的临床应用效果.方法 回顾性分析2016年7月至2017年7月我院创伤骨科收治的18例陈旧性跟腱断裂病人的临床资料,其中男10例,女8例,平均年龄为42岁(32～55岁),左侧损伤6例,右侧损伤12例,跟腱缺损范围平均为5.8 cm(4～8 cm),手术方式为改良切口...     

改良腱膜瓣修补术修复跟腱断裂

1996年 1月～ 1 999年 7月 ,采用我院设计的改良腱膜瓣修补术修复开放性跟腱断裂 5例 ,术后既能达到修补的目的 ,又能减少跟腱与皮肤的粘连 ,效果良好 ,报告如下。1　临床资料1 .1　一般资料开放性跟腱断裂 5例 ,男 4例 ,女 1例。年龄1 8～ 37岁。就诊时间 :伤后 4小时以内 4例 ,35天 1例。刀砍伤 3例 ,玻璃割伤 2例。跟腱均完全断裂 ,距离跟骨附着处 2～ 4cm,1例跖肌腱未断裂 ;横形断裂 4例 ,短斜形断裂 1例 ,跟腱断端整齐 ,无皮肤缺损。急诊手术修复 4例 ,二期手术修复 1例。1 .2　手术方法持续硬膜外麻醉或腰麻。常规清创 ,检查跟腱断端…     

跟腱再断裂的修复重建

 目的 总结跟腱再断裂的原因, 探讨野V-Y冶推进瓣及长屈肌腱(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4 cm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-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。 采用野V-Y冶推进瓣或 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。 腓肠肌腱膜野V-Y冶推进瓣可修复4 cm的缺损, 术后踝足部功能外形恢复良好。     

Combined flexor hallucis longus tendon transfer and gastrocnemius recession for reconstruction of gapped chronic achilles tendon ruptures

ObjectiveThe aim of this study was to assess the functional outcomes after a combined FHL transfer and a gastrocnemius recession for treatment of chronic ruptures of Achilles tendon with a gap and to investigate the patient's satisfaction about the great toe function after transfer.Material and methods19 patients with chronic rupture of the Achilles tendon with a gap were treated with a flexor halluces longus tendon transfer combined with a gastrocnemius recession, Clinical diagnosis depends on the presence of gap in the tendon on examination, inability of tip toe walking on the affected side and positive calf-squeeze test, MRI was used to confirm the clinical diagnosis. American Orthopedic Foot & Ankle Society hind foot score was used for assessment of the results.ResultsThe AOFAS score improved significantly from a mean of 65 preoperatively to 94 at the last follow up (p < 0.001), there was no significant difference in the final outcome between patients with FHL tendon weaved through the stump of the Achilles tendon and those with trans osseous tunnels, the mean AOFAS score at the last follow up was 94.2, 93.8 respectively, no patient complained of big toe dysfunction.ConclusionManagement of chronic rupture of the Achilles tendon with a gap with flexor halluces longus tendon transfer combined with a gastrocnemius recession is a safe and reliable method with a significantly improved functional outcome, muscle advancement through gastrocnemius recession decreases the length of the gap without affecting the muscle function, flexor halluces longus tendon transfer doesn't harm the big toe function.     

Surgical reconstruction of chronic achilles tendon ruptures using various methods

The purpose of this study was to evaluate the surgical outcomes of reconstruction of chronic Achilles tendon ruptures using various methods, including Achilles tendon allograft. Between October 2003 and March 2010, twelve patients with chronic Achilles tendon ruptures and a defect gap of >4 cm underwent surgical reconstruction with V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus tendon transfer, or Achilles tendon allograft. The study group comprised 11 men and 1 woman. At last follow-up, all patients were assessed with regard to postoperative complications, self-reported level of satisfaction, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score, repetitive single-heel rises, single-leg hopping test, and ankle range of motion. The AOFAS scores increased from an average of 68.7 (range, 50-87) preoperatively to 98.0 (range, 88-100) postoperatively. All patients were able to perform 10 repetitive single-heel raises and single-leg hops at last follow-up. No patient experienced wound complications or deep infection. Seven patients were rated as excellent, 4 as good, and 1 as fair. Chronic Achilles tendon ruptures can be successfully treated by careful selection of the reconstruction method according to the length of defect gap and state of the remaining tissue. With an extensive defect, use of an Achilles tendon allograft can be a good option.     

A survey on management of chronic achilles tendon ruptures

No controlled trials regarding management of chronic Achilles tendon ruptures have been published. We conducted an online survey of orthopedic surgeons affiliated with US medical schools. One hundred twenty-seven surgeons responded, but not all responded to each survey question. Thirty-six percent had foot and ankle fellowship training. Nearly all respondents diagnosed tendon rupture by using palpation of the tendon gap (97%) and the Thompson calf-squeeze test (96%). The Matles test was used by 37% of respondents, with foot and ankle specialists nearly 5 times more likely to use it than nonspecialists (P<.001). For surgical repair of a ruptured tendon, most surgeons used the end-to-end Bunnell technique for gaps of a few centimeters, transitioning to the flexor hallucis longus procedure or V-Y tendinoplasty for larger gaps. Ninety-three percent of respondents used nonabsorbable sutures; absorbable suture use tended to increase with years of practice. Most surgeons (72%) preferred postoperative immobilization for up to 6 weeks and non-weight-bearing for up to 6 weeks (96%). In most instances, the responses of foot and ankle specialists did not differ significantly from those of other orthopedic surgeons, allowing generalization of the survey results to practice trends among all orthopedic surgeons. Practice trends tended to follow published expert opinions.     

Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials

BACKGROUND: There is a lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture. Treatment can be broadly classified as operative (open or percutaneous) or nonoperative (casting or functional bracing). Postoperative splinting can be performed with a rigid cast (proximal or distal to the knee) or a more mobile functional brace. The aim of this meta-analysis was to identify and summarize the evidence from randomized, controlled trials on the effectiveness of different interventions for the treatment of acute Achilles tendon ruptures. METHODS: We searched multiple databases (including EMBASE, CINAHL, and MEDLINE) as well as reference lists of articles and contacted authors. Keywords included Achilles tendon, rupture, and tendon injuries. Three reviewers extracted data and independently assessed trial quality with use of a ten-item scale. RESULTS: Twelve trials involving 800 patients were included. There was a variable level of methodological rigor and reporting of outcomes. Open operative treatment was associated with a lower risk of rerupture compared with nonoperative treatment (relative risk, 0.27; 95% confidence interval, 0.11 to 0.64). However, it was associated with a higher risk of other complications, including infection, adhesions, and disturbed skin sensibility (relative risk, 10.60; 95% confidence interval, 4.82 to 23.28). Percutaneous repair was associated with a lower complication rate compared with open operative repair (relative risk, 2.84; 95% confidence interval, 1.06 to 7.62). Patients who had been managed with a functional brace postoperatively (allowing for early mobilization) had a lower complication rate compared with those who had been managed with a cast (relative risk, 1.88; 95% confidence interval, 1.27 to 2.76). Because of the small number of patients involved, no definitive conclusions could be made regarding different nonoperative treatment regimens. CONCLUSIONS: Open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with nonoperative treatment, but operative treatment is associated with a significantly higher risk of other complications. Operative risks may be reduced by performing surgery percutaneously. Postoperative splinting with use of a functional brace reduces the overall complication rate. LEVEL OF EVIDENCE: Therapeutic Level I.     

小切口微创治疗新鲜跟腱断裂

[目的]探讨通过小切口应用跟腱缝合引导器微创治疗新鲜跟腱断裂的临床效果.[方法]2006年3月-2008年3月,通过小切口应用跟腱缝合引导器微创治疗连续的26例新鲜跟腱断裂病人,术后早期功能锻练.男24例,女2例.年龄22～58岁,平均37.6岁.24例获得12～36个月(平均21个月)的随访.采用美国足与踝关节协会(AOFAS)踝与后足功能评分标准进行评分,测量双侧小腿最大周径及跟腱断裂平面的周径,询问恢复工作及伤前体育活动的时间.[结果]无跟腱再断裂、切口表浅或深部感染、皮缘坏死等并发症.腓肠神经支配区皮肤感觉正常.AOFAS 平均得分为97分(86～100分).23例恢复伤前工作与学习,恢复工作时间平均为10周(4～20周).24例均恢复伤前体育活动,恢复伤前体育活动时间平均为20周(18～24周).小腿最大周径伤侧较对侧平均减少0.4 cm(0.2～0.8 cm),跟腱断裂平面周径伤侧较对侧平均增粗0.5 cm(0.3～0.7 cm).[结论]应用跟腱缝合引导器微创修复新鲜跟腱断裂结合早期功能锻练可得到满意的临床效果,可较早恢复伤前状态,有较少的并发症.