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。     

腓肠肌腱膜松解联合跟腱断端瘢痕组织缝合治疗陈旧性跟腱断裂

目的:探讨腓肠肌腱膜松解后跟腱断端瘢痕组织缝合治疗陈旧性跟腱断裂的临床疗效.方法:回顾性分析2017年1月至2019年12月收治的17例陈旧性跟腱断裂患者的临床资料,其中男15例,女2例,年龄26～53(35.2±11.6)岁,受伤至手术时间37～92(49.3±13.3)d.Myerson分型Ⅱ型6例,Ⅲ型11例.术...     

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Arner—Lindhohm评定标准判定,优12例,良3例,差1例,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。     

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。     

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...     

腓肠肌腱瓣翻转修复跟腱断裂

[目的]评价腓肠肌腱瓣翻转治疗跟腱断裂的手术疗效及方法。[方法]对跟腱断裂的35例患者行手术治疗，手术方法采用腓肠肌腱瓣翻转修复断裂的跟腱，术后进行康复训练。平均随访18个月，根据Arner Lindholm评分标准对治疗效果进行评价。[结果]35例患者均获得随访，32例随访1年以上。患者终末评价结果：优：29例，良：2例，差：1例。优良率97．1％。[结论]腓肠肌腱瓣翻转修复跟腱断裂疗效良好，术后康复训练是保证术后疗效的重要环节。     

吻合血管的阔筋膜瓣移植修复跟腱缺损

闭合性跟腱断裂因漏诊而延误治疗,在临床上并不少见,由于断端回缩,跟腱缺损,失去了直接缝合的机会。应用游离阔筋膜瓣修复疗效不甚满意［１～３］。１９８７年以来,我们应用旋股外侧动脉降支的肌皮动脉穿支或肌间隙皮支为血供的阔筋膜瓣,行吻合血管移植修复,取得了...     

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。     

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     

Extensive Achilles tendon ossification: Repair using a fascia lata graft

Ossification of the Achilles tendon is a relatively common finding. However, a large ossification covering more than two third of the tendon is rarely seen. A 70 year old patient with a 12 cm long Achilles tendon ossification is discussed. The ossification was surgically removed and the tendon was subsequently reconstructed using a fascia lata autograft. Postoperatively the ankle was immobilised for 3 months. One year postoperatively the patient was completely recovered with the ability to stand on his toes, and minimal loss in range of motion.Level of clinical evidence4     

Treatment of a symptomatic forearm muscle herniation with a wrap-around fascia lata graft

Muscle herniation in the extremity is a well-recognized cause of symptomatic pain on exertion. Only 17 cases involving the upper limb has been previously described, 11 of them involving the anterior compartment of the forearm and only 2 were caused by strenuous exertion. Treatment for this condition ranged from nonsurgical, primary closure with palmaris longus interweave, formal fasciotomy, to closure with a tensor fascia lata graft. This is a study of a 28-year-old man who had a symptomatic swelling on the volar aspect of his left forearm while working on a car-door assembly line that resulted in a significant decreased of his grip strength, work capacity and median nerve symptoms. It did not improve after 6 months of conservative management including hand therapy and splintage. The patient subsequently underwent a tensor fascia lata graft wrap-around. Postoperatively his symptoms resolved with improvement in his grip strength and hand function. The rationale for the treatment option chosen is discussed.     

Reconstruction of bilateral tendoachilles with fascia lata graft

A 19 year old male presented with progressive enlargement of both tendoachilles for 2 years and difficulty in walking for 3 months. The neurological history and examination revealed progressive mental deterioration and ataxia. The blood investigation revealed hypercholesterolemia. We report this rare case of cerebrotendinous xanthomatosis with bilateral tendoachilles enlargement, which was treated by excision of bilateral tendoachilles and reconstruction with fascia lata. The American Orthopedic Foot and Ankle Society hindfoot score was 93/100 bilaterally and the subjective evaluation of the patient showed very good results.     

比目鱼肌肌腱瓣移位重建跟腱术

目的介绍比目鱼肌肌腱瓣移位重建跟腱术的方法及临床效果。方法在对参与跟腱组成的小腿浅层各肌肉的解剖特点进行仔细观察的基础上，设计了比目鱼肌肌腱瓣移位重建跟腱的术式，临床应用于12例伴有缺损的跟腱损伤患者的治疗，并进行了平均39个月的随访。结果根据Arner-Lindholm疗效评定标准，优9例，良2例，差1例，优良率达92％。结论比目鱼肌肌腱瓣移位重建跟腱术，具有损伤小、对跟腱血供的影响小、术后愈合好的优点。     

V-Y腱成型术加带蒂筋膜覆盖治疗跟腱再断裂

目的 探讨V-Y腱成型术加带蒂筋膜覆盖治疗跟腱再断裂的疗效。方法 19例患者均应用V-Y腱成型术修复,同时采用带蒂筋膜覆盖跟腱吻合处。结果 术后随访2～5年,平均3．1年。按Amer-Lindhohn疗效标准进行评定,优14例,良4例,差1例。结论 V-Y腱成型术修复跟腱再断裂,疗效满意,而加以带蒂筋膜覆盖,则有效地减少术后并发症,促进跟腱的愈合。     

阔筋膜结合锚钉治疗腓骨肌腱滑脱疗效观察

目的 :探讨应用锚钉结合阔筋膜治疗腓骨肌腱滑脱。方法 :自2011年2月至2014年3月采用自体阔筋膜条编织后结合带线锚钉重建腓骨肌腱上支持带治疗腓骨肌腱滑脱12例,其中男9例,女3例;年龄14~23岁,平均17岁。术前均存在踝关节疼痛,不能剧烈运动。结果 :12例患者切口全部甲级愈合,无感染、不愈合。所有患者定期复查,随访时间6个月~3年,平均18个月。术后踝关节疼痛明显好转,运动功能恢复,踝关节功能应用Mazur踝关节症状与功能评分系统评分,平均(91.92±3.17)分。结论:阔筋膜结合锚钉治疗腓骨肌腱滑脱具有取材区创伤小,操作简单,术后功能恢复满意的良好效果。     

Repair of neglected Achilles tendon rupture using gastrocnemius fascial flaps

Background. Neglected Achilles tendon rupture is a rare disorder. In this article, we discuss the results of 10 patients with neglected Achilles tendon ruptures who were treated surgically. Methods. Between 1980 and 1997, we treated 10 patients (6 men and 4 women) using gastrocnemius fascial flaps according to the method described by Lindholm. The mean age of the patients at the time of the operation was 51 years (range 38–57 years). They were followed-up for 26–192 months. Results. There were significant differences between the American Orthopaedic Foot and Ankle Society (AOFAS) scale score before the operation (72.6±5.3) and the score at the most recent follow-up (98.1±2.5) (p<0.0001). On Cybex isokinetic strength testing, the peak torque deficiencies in plantar flexion ranged from 8% to 68% at the low setting and from 19% to 33% at the high setting preoperatively, and ranged from –9% to 17% at the low setting and from –13% to 23% at the high setting postoperatively. There were no re-ruptures. Conlusion. Our data indicate that the reconstructive technique using gastrocnemius fascial flaps can result in an excellent clinical and functional outcome.