阔筋膜移植治疗陈旧性跟腱断裂

目的总结采用阔筋膜移植治疗陈旧性跟腱断裂的疗效。方法对16例患者采用阔筋膜移植修复陈旧性跟腱断裂并随访。结果全部病例均经2～3年（平均28个月）的随访，按Amer-Lindhohm评定标准判定，临床优良率达93．8％。结论阔筋膜移植治疗陈旧性跟腱断裂是一种效果较好的方法。     

胭绳肌腱移植修复陈旧性跟腱断裂

目的 介绍腘绳肌腱移植修复陈旧性跟腱断裂的方法和经验.方法 对15例陈旧性跟腱断裂采用胭绳肌腱移植修复.结果 随访6～15个月,平均9个月,采用Arner-Lindholmliao疗效评定标准:优12,良3例.结论 采用胭绳肌腱移植治疗陈旧性跟腱断裂是一种较好的方法,值得推广.     

腘绳肌腱移植修复陈旧性跟腱断裂

目的介绍腘绳肌腱移植修复陈旧性跟腱断裂的方法和经验。方法对15例陈旧性跟腱断裂采用腘绳肌腱移植修复。结果随访6-15个月,平均9个月,采用Amer—Lindholmliao疗效评定标准：优12,良3例。结论采用腘绳肌腱移植治疗陈旧性跟腱断裂是一种较好的方法,值得推广。     

四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位治疗陈旧性跟腱断裂的疗效比较

背景：多数学者认为陈旧性跟腱断裂应行手术治疗。目前,手术修复缺损的方法多种多样。目的：比较四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位修复陈旧性跟腱断裂的临床疗效。方法：2002年3月至2009年12月收治陈旧性跟腱断裂患者29例,均为单侧陈旧性跟腱完全性断裂。应用四股胭绳肌腱经跟骨隧道移植修复16例（A组）,应用腓骨长肌转位修复13例（B组）。术后两组均常规使用抗生素,并行功能锻炼,采用Arner-Lindholm标准评价治疗效果。结果：两组患者均获得随访,随访时间24-60个月,平均39个月。按照Amer-Lindhohm评定标准判定,A组：优15例,良l例,临床优良率达100％。B组：优9例,良3例,差1例,临床优良率达92．3％。A组优于B组,差异有统计学意义（P〈0．05）。结论：四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位术均是治疗陈旧性跟腱断裂的有效方法,但前者优于后者,值得临床推广应用。     

应用同种异体肌腱移植修复陈旧性跟腱断裂

目的探讨应用同种异体肌腱移植修复陈旧性跟腱断裂的手术方法. 方法 1996年7月～2000年11月,对6例陈旧性跟腱断裂患者行经过深低温处理的同种异体屈指肌腱移植.在跟腱近、远断端间立体双8字交叉移植进行修复,恢复跟腱断端的连续性和强度. 结果术后6例中有5例获2年以上随访,时间27～53个月.5例切口Ⅰ期愈合,1例切口皮缘坏死,经换药愈合.采用Arner-Lindholm疗效评定方法评估获随访的5例术后功能,优1例,良4例. 结论异体肌腱移植修复陈旧性跟腱断裂,可避免自体取材造成的损伤及可能引起的并发症,供材可提前制作,缩短了手术时间,是一种可行的手术方法.     

改良V-Y肌腱瓣修补术治疗陈旧性Kuwada Ⅳ型跟腱断裂

目的探讨改良V-Y肌腱瓣修补术治疗陈旧性KuwadaⅣ型跟腱断裂的临床效果。方法对21例陈旧性Kuwada Ⅳ型跟腱断裂患者采用改良V-Y肌腱瓣修补术治疗。患者跟腱缺损长度为6.5~10.2 cm。结果患者均获得随访,时间8个月~5年。按Amer-Lindholm评分标准评价疗效:优16例,良3例,差2例。结论改良V-Y肌腱瓣修补术治疗陈旧性Kuwada Ⅳ型跟腱断裂可有效解决跟腱缺损,临床疗效满意。     

改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂

目的探讨改良Bosworth术联合应用可吸收防粘连膜治疗陈旧性跟腱断裂的效果。方法14例陈旧性跟腱断裂病例采用改良Bosworth法重建后,可吸收防粘连膜包绕肌腱的术式予以治疗。跟腱缺损范围3．6～10cm,平均6.3cm。结果平均随访29个月。按Arner-Lindholm疗效评定标准评估,优12例,良2例。结论改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂临床疗效满意,具有良好的应用前景。     

陈旧性跟腱断裂的手术治疗及术后康复

目的总结手术治疗的56例陈旧性跟腱断裂病例,观察几种术式在治疗陈旧性跟腱断裂中的作用以及术后严格进行康复治疗的意义。方法对56例陈旧性跟腱断裂患者采用以＂抽出式钢丝固定＋跟腱断端环形缝合术＂为基础,术中根据跟腱断端缺损长度、病理特点选择手术方式。其中8例断端缺损小于等于2 cm直接采用此法,42例跟腱断端缺损超过2 cm加行倒V-Y腱成形术,3例跟腱缺损同时有皮肤缺损者则加行内、外侧腓肠肌联合肌皮瓣修复术,3例跟腱部分断裂者采用腱膜翻转修复术仅修复缺损部分肌腱。术后分阶段进行运动治疗、理疗等康复治疗。结果 56例患者获得6个月～10年随访,平均随访时间5年,按照Amer-Lindholmpin评定法评定,优43例,良13例,优良率100%。结论在对陈旧性跟腱断裂采用手术治疗时,根据损伤类型和术中探查的情况选择合适的手术方式是取得良好疗效的基础,术后规范、严格的康复训练是取得良好疗效的重要措施。     

陈旧性跟腱断裂的外科治疗

目的探讨陈旧性跟腱断裂的外科治疗和康复指导。方法对16例陈旧性跟腱断裂患者,采用Lindholm术式、Abraham术式和采用跖肌腱与跟腱混合编织的Lindholm改良成形加固术式修复,术后严守康复规程辅以中药熏洗治疗,平均3年随访,按Arner-Lindholm疗效标准评定。结果优12例,良3例,差1例,优良率93.8%。结论陈旧性跟腱断裂多为切割伤和运动伤。手术方式应根据跟腱损伤的性质、程度和病理变化而定,遵循合理规范的康复程序是取得最佳疗效的重要环节。     

腓肠肌腱膜瓣翻转联合阔筋膜移植治疗跟腱再断裂

目的:探讨腓肠肌腱膜瓣翻转联合阔筋膜移植修复跟腱再断裂的临床疗效。方法 :自2013年7月至2017年4月,对11例跟腱术后再断裂患者采用腓肠肌腱膜瓣翻转联合阔筋膜移植重建治疗,男10例,女1例;年龄25～48岁。所有患者术前患足跖屈力量减弱、单足提踵试验阳性。观察术后并发症,并于术后6个月采用美国足踝外科学会踝-后足功能评分(AOFAS)进行功能评价。结果:本组11例患者获得随访,时间6～11个月。所有患者手术切口均Ⅰ期愈合,无皮肤坏死、切口感染、深静脉血栓、再断裂等并发症。跟腱缺损长度4～7 cm。患者完全恢复负重时间8～11周。术后6个月AOFAS评分79～100分,其中优9例,良2例。结论:腓肠肌腱膜翻转联合阔筋膜移植修复跟腱再断裂,具有跟腱修复可靠,并发症少,跟腱功能恢复良好的优点,是一种有效的临床治疗方法。     

腓肠肌腱膜翻转术在陈旧性跟腱断裂中的应用

目的探讨应用腓肠肌腱膜翻转法治疗陈旧性跟腱断裂的疗效。方法对18例陈旧性跟腱断裂患者应用腓肠肌腱膜翻转术重建跟腱。术中于小腿中部腓肠肌腱膜-肌移行处切取一条长8～10 cm、宽3 cm带蒂腓肠肌筋膜瓣,其基底留在离断端上方约1.5～2 cm处,于蒂上方跟腱中心作一纵切口,把腱膜瓣从此切口中穿过,再反折向下,由跟腱两侧向浅面包绕跟腱远近端及其缺损。自跟骨结节撕脱者将跟骨结节咬成粗糙面,腱膜条拉紧,根据缺损长度修剪腱膜条远端,使之与跟骨结节相接触。然后用Bunnell抽出钢丝法将重建跟腱拉紧,使踝关节跖屈约20°。结果本组有3例切口延迟愈合,无皮肤及肌腱坏死、无深部感染及再断裂病例。所有患者平均随访26（24～40）个月,按Arner-Lindholm标准评定,优13例,良5例,临床疗效良好。结论腓肠肌腱膜翻转术治疗陈旧性跟腱断裂具有手术操作简单、固定牢固、愈合率高、并发症少等优点,是一种较为理想的重建方法。     

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.     

Interwoven wire suture with fascia lata-plasty in the treatment of subcutaneous rupture of the Achilles tendon--an obsolete method?

Lately there has been an increased incidence of rupture of the Achilles tendon following the general increase in mass sports. Surgery is the treatment of choice, and various methods are being described. We have been using the wire suture method with fascia lata plasty for more then twenty years. The rate of infection is 3.8% and that of rerupture 1.2%, figures that correspond to those stated for other surgical methods. Moreover, 87% of the patients were very satisfied with the result of the operation; they are fit for work without any restriction, and some of them even practise their sports activities as before. For this reason we consider that wire suturing with fascia lata plasty is by no means obsolete in the treatment of rupture of the Achilles tendon.     

应用同种异体肌腱加强修复治疗陈旧性跟腱断裂

目的探讨同种异体肌腱加强修复治疗陈旧性跟腱断裂的临床疗效。方法2005年1月至2011年12月,对26例陈旧性跟腱断裂患者,采用同种异体肌腱在跟腱断裂两侧的正常跟腱组织冠状面钻孔环扎,加强修复断裂的跟腱。结果26例均获随访9～52个月,平均30．7个月,除1例术后伤口延迟愈合外,其余伤口均I期愈合,无全身或局部不良反应,无跟腱黏连再手术者,无跟腱再断裂发生。采用Arner—Lindholm疗效评定方法,优22例（84．6％）,良4例（15．4％）。结论同种异体肌腱加强修复治疗陈旧性跟腱断裂疗效满意,并发症少,手术操作简单,是一种可行的手术方法。     

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.     

Lindholm法治疗陈旧性跟腱断裂的疗效分析

目的评价Lindholm法治疗陈旧性跟腱断裂的疗效。方法对17例陈旧性跟腱断裂患者行Lindholm法手术治疗修复重建跟腱连续性,术后石膏外固定6周,之后进行康复训练。结果17例均获得随访,时间8～24个月,根据Amer-Lindholm评分标准进行疗效评价：优12例,良4例,差1例。结论Lindholm法治疗陈旧性跟腱断裂,结合术后合理的康复功能锻炼,功能恢复满意,疗效可靠。     

Reconstruction of soft tissue defects including the Achilles tendon with free neurovascular tensor fascia lata flap and fascia lata. Case report

The combined loss of the Achilles tendon and the overlying soft tissue in the young ambulant patient with expectations of a normal life is a challenge. These patients need not only skin coverage but also dynamic, functioning repair. Two cases of major defects after tumour resection are presented. In each case the tendon was reconstructed using the remaining gastrocnemius aponeurosis reinforced with fascia lata. This was covered by a free tensor fascia lata (TFL) flap. In one of the cases the flap was transferred as a neurovascular free flap.     

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。