微创切取全长长屈肌腱重建陈旧性KuwadaⅣ型跟腱断裂

 目的 探讨微创切取全长长屈肌腱重建陈旧性Kuwada Ⅳ型跟腱断裂的临床效果。方法回顾性分析 2006 年7 月至2011 年6月,微创切取全长长屈肌腱重建35例陈旧性KuwadaⅣ型跟腱断裂患者资料,男21例,女14例;年龄为23～71岁,平均42.1岁;均为单侧损伤。MRI 示跟腱断裂间隙为6.0～9.2 cm。观察术后踝关节外形及功能恢复情况,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及Leppilahti跟腱修复评分评价疗效。结果 32例获得随访,随访时间为 18～72个月,平均33.2个月。除1例患者因术后10 d拆线致切口裂开重新缝合6周后获得延迟愈合外,其余患者切口均一期愈合。术后踝关节外形及功能恢复良好,AOFAS踝与后足评分从术前(51.92±7.08)分提高到术后(92.56±6.71)分;其中优27例,良3例,可2 例,优良率为93.8%(30/32)。Leppilahti跟腱修复评分从术前(72.56±7.43)分提高到术后(92.58±5.1)分。无一例发生腓肠神经及胫神经损伤、跖部痛性瘢痕、足底内外侧神经损伤。踝关节MRI示跟腱部信号均匀无撕裂和囊性变。结论 微创切取长屈肌腱转移重建陈旧性KuwadaⅣ跟腱断裂具有术后恢复快、肌腱固定强度高、并发症少的优点。     

拇长屈肌腱转位结合挤压螺钉重建KuwadaⅣ型陈旧性跟腱断裂

目的:探讨拇长屈肌腱转位后应用挤压螺钉重建陈旧性KuwadaⅣ型跟腱断裂的临床效果。方法:回顾性分析2010年9月至2012年6月,拇长屈肌腱转位后采用挤压螺钉固定重建26例陈旧性跟腱断裂患者的临床资料,其中男18例,女8例;年龄20～66岁,平均44.2岁。所有患者为单侧损伤。MRI显示跟腱断端距离为6.0～9.0 cm.观察术后并发症情况,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及Leppilahti跟腱修复评分进行评价疗效。结果:26例获得随访,时间18～68个月,平均30.4个月。术后无神经损伤及切口感染,所有患者切口Ⅰ期愈合。术后踝关节外形及功能恢复良好,AOFAS踝与后足评分由术前52.27±12.30提高至术后90.92±6.36(t=-18.26,P<0.05).Leppilahti跟腱修复评分术前34.23±12.86提高至术后90.00±5.10分(t=-22.67,P<0.05).结论:拇长屈肌腱转位后应用挤压螺钉固定来重建陈旧性KuwadaⅣ型跟腱断裂具有操作简单,术后恢复快、肌腱固定牢靠、并发症少的优点。     

■长屈肌腱转位重建kawande Ⅱ-Ⅳ型跟腱缺损

[目的]探讨和总结■长屈肌腱转位修复和重建kawandeⅡ-Ⅳ型跟腱缺损的临床疗效。[方法]回顾性分析2008年1月～2016年1月采用■长屈肌腱转位修复和重建kawandeⅡ-Ⅳ型17例跟腱缺损患者的临床资料,其中男8例,女9例;年龄30～60岁,平均(48.28±8.56)岁。均为单侧跟腱断裂,跟腱缺损2～6.5 cm,切取■长屈肌腱分别为15～38 cm;跟腱修复后观察恢复工作时间、踝关节的肌力、活动范围及手术并发症,并采用通用的Leppilahti跟腱修复评分系统进行疗效评价。[结果] 17例患者均顺利完成手术,无血管、神经损伤等并发症发生。17例均获随访,随访时间1～8年,平均(1.73±1.31)年。拆线时间14～30 d,平均(19.62±3.77) d,恢复工作时间3～5个月,平均(3.91±0.39)个月,踝关节肌力均在4级以上,活动好,外形恢复好,■趾屈伸功能不受影响;无切口溃烂、跟腱外露、持久不愈的病例,无跟腱再次断裂者。Leppilahti跟腱修复评分78.13～95.82分,平均(90.02±5.10)分,其中优13例,良4例。[结论]■长屈肌腱长度足、质量好、修复和重建kawandeⅡ-Ⅳ型跟腱缺损质量高,功能和外形好,恢复快,并发症少。     

V-Y推进结合踇长屈肌腱转位修复KuwadⅢ型慢性跟腱损伤的疗效观察

目的：探讨V-Y推进结合踇长屈肌腱转位修复Kuwad Ⅲ型慢性跟腱损伤的手术技巧和临床疗效。方法选择2012年2月-2014年2月收治的26例慢性跟腱断裂患者,其中男20例,女6例;年龄18~65岁,平均34.6岁,术中跟腱清创后腱缺损为3~5 cm。采用有限切开V-Y推进结合踇长屈肌腱转位进行治疗,记录损伤愈合时间及相关并发症,并比较术前与末次随访时美国骨科足踝外科协会后足评分、疼痛视觉模拟评分量表及Leppilahti跟腱修复评定标准评分,采用配对样本t检验。结果21例患者术后获12~26个月(平均16.4个月)门诊随访,5例失访。患者切口均一期愈合,无感染、神经损伤及跟腱再断等并发症发生。术后MRI示跟腱愈合时间平均为12周,挤压螺钉骨化时间平均为18个月。末次随访时,21例患者美国骨科足踝外科协会中足评分由术前平均(52.6±15.4)分上升至(96.8±2.5)分;疼痛视觉模拟评分量表评分由术前平均(5.71±1.56)分降低至(1.24±0.44)分;依据Leppilahti跟腱修复评分从术前(68.56±7.43)分提高到术后(92.58±5.1)分。以上项目术前与末次随访时比较差异均有统计学意义(均P<0.05)。结论 V-Y推进结合踇长屈肌腱转位治疗慢性跟腱损伤较适合断端缺损在3~5 cm间的患者,该方法操作简单、并发症少,是一种安全、有效的手术选择。     

趾长屈肌腱和长屈肌腱移位修复陈旧性跟腱断裂

目的：探讨趾长屈肌腱、[足母]长屈肌腱移位修复陈旧性跟腱断裂的手术方法和疗效。方法：13例陈旧性跟腱断裂患者,男9例,女4例;年龄32～69岁,平均41岁;左侧8例,右5例;受伤至手术时间3～8个月,平均4.5个月。13例患者均有明确外伤史,均为闭合性损伤跟腱断裂。采用趾长屈肌腱移位修复陈旧性跟腱断裂5例,行[足母]长屈肌腱移位修复陈旧性跟腱断裂8例。结果：13例随访时间11个月～4.5年,平均2年,伤口无感染,跟腱无再断裂,踝关节活动基本正常,足背屈跖屈功能良好,未发生锤状趾畸形。按Arner-Lindholm疗效评定标准评定,优9例（[足母]长屈肌腱移位修复6例,趾长屈肌腱移位修复3例）,良3例（[足母]长屈肌腱移位修复2例,趾长屈肌腱移位修复1例）,差1例（趾长屈肌腱移位修复）。结论：采用趾长屈肌腱、[足母]长屈肌腱移位修复陈旧性跟腱断裂的手术方法,可获得良好的疗效,是较理想的治疗方法。而采用长屈肌腱移位修复陈旧性跟腱断裂更趋近于合理。     

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。     

(足母)长屈肌腱移位替代跟腱治疗跟腱缺损的疗效分析

目的 探讨(足母)长屈肌腱移位替代跟腱治疗6 cm以上跟腱缺损的疗效.方法 2005年1月至2009年2月采用(足母)长屈肌腱移位替代跟腱治疗19例跟腱缺损患者,男13例,女6例;年龄20～61岁,平均(42.6±8.2)岁;跟腱炎清创后跟腱缺损15例,其中10例合并急性跟腱断裂;陈旧性跟腱断裂4例.跟腱断裂至手术时间为0～6个月(平均2.6个月).跟腱缺损长度为6～10 cm.19例患者均采用两切口(足母)长屈肌腱移位替代跟腱术治疗.记录患者术后3个月、1年及末次随访时的踝关节活动度、美国足踝外科协会(AOFAS)踝与后足评分与视觉模拟法(VAS)疼痛评分,并进行统计学比较.评价患者术后足踝部功能的恢复情况及患者的满意度. 结果 19例患者术后获12～48个月(平均22.2个月)随访.患者末次随访时踝关节背伸、跖屈及AOFAS踝与后足评分平均分别为17.8°±1.9°、39.1°±2.3°及(91.8±1.7)分,与术后3个月比较差异均有统计学意义(P＜0.05),与术后1年比较差异无统计学意义(P＞0.05),术后3个月与术后1年比较差异有统计学意义(P＜0.05);VAS疼痛评分平均为(1.0±0.7)分,与术后3个月和术后1年比较差异均有统计学意义(P＜0.05),术后3个月与术后1年比较差异有统计学意义(P＜0.05).术后患者对手术满意率达100%. 结论 (口止母)长屈肌腱移位替代跟腱术是一种有效的手术方式,适用于跟腱较长缺损时的重建治疗.手术可以明显解除疼痛,改善足部功能,且对足部影响较小.     

长屈肌腱转位手术治疗老年跟腱断裂的疗效分析

背景：慢性跟腱疾病发展到后期往往需要行肌腱转位治疗,长屈肌腱转位手术是常用的治疗方式。但老年患者的功能恢复、生活方式有别于其他人群。目的：探讨长屈肌腱转位手术治疗老年人跟腱断裂的临床效果。方法：回顾性分析2007年9月至2012年7月在我院行长屈肌腱转位手术的老年患者的病例资料（＞60岁）。共14例（16足）,男女各7例,年龄60~83岁,平均67.1岁。2例女性患者为双侧跟腱断裂同时行手术修补,均采用单切口长屈肌腱转位替代跟腱疗法。分别评估患者术前与术后美国足踝外科协会踝-后足评分（AOFAS-AH）,美国足踝外科协会趾-跖趾-趾间关节评分（AOFAS-MTPIP）,视觉模拟法（VAS）疼痛评分,跟腱断裂评分（ATRS）及手术相关并发症情况。最后进行统计学比较,评价患者足踝部功能恢复情况及患者满意情况。结果：14例患者术后获得21~67个月随访。AOFAS-AH评分从术前（68.2±6.2）分提高到术后的（93.2±5.3）分;AOFAS-MTPIP评分术前为（94.2±2.9）分,术后为（95.1±3.2）分;VAS评分术前（5.1±1.4）分,术后为（1.0±0.7）分;ARTS评分从术前（52.7±9.3）分提高到术后（86.3±10.3）分。16足术后均未出现伤口感染等手术并发症,也未在围手术期出现肺部感染、深静脉血栓等其他并发症。结论：长屈肌腱转位手术在老年人中的应用不但具有很好的手术疗效,并且安全性较高。     

全关节镜下自体肌腱重建治疗陈旧性跟腱断裂

目的探讨全关节镜下自体肌腱重建治疗陈旧性跟腱断裂的疗效。方法 2015年6月—2018年6月,采用全关节镜下自体肌腱重建治疗16例陈旧性跟腱断裂。男11例,女5例;年龄21～55岁,平均40.7岁。病程14～20个月,平均16.4个月。美国矫形足踝协会(AOFAS)评分为(41.2±2.2)分,疼痛视觉模拟评分(VAS)为(7.9±1.2)分。MRI以及B超检查提示跟腱连续性不佳。跟腱缺损长度为5.0～10.3 cm,平均5.8 cm。4例于跟腱止点上方断裂,12例为腱腹交界区断裂。记录手术时间、术中出血量、住院时间及相关并发症发生情况,采用AOFAS评分及VAS评分评价关节功能及疼痛改善情况。结果手术时间60～90 min,平均77.2 min。术中出血量15～30 mL,平均20.5 mL。术后住院时间5～10 d,平均7.2 d。术后切口均Ⅰ期愈合,无皮肤坏死、感染以及下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间8～18个月,平均12个月;其中10例随访达12个月以上。随访期间均未出现跟腱再断裂,疼痛以及提踵不能症状均较术前明显改善。MRI复查提示跟腱连续性恢复。术后1、3、6、12个月AOFAS评分均较术前明显提高,VAS评分明显降低,除术后1个月外,其余时间点与术前比较差异均有统计学意义(P0.05)。结论全关节镜下自体肌腱重建治疗陈旧性跟腱断裂,具有创伤小、术后功能恢复快的优势,可获得较好疗效。     

拇长屈肌腱转位治疗顽固性跟腱止点病

目的探讨拇长屈肌腱转位治疗顽固性跟腱止点病的临床疗效。方法对30例顽固性跟腱止点病患者采用跟腱清创、拇长屈肌腱转位的术式进行跟腱重建。采用VISA-A评分评价疗效。结果患者均获得随访,时间25～43个月。VISA-A评分:术前为37. 50分±2. 70分,末次随访时为80. 80分±3. 10分,差异有统计学意义(P 0. 01)。1例因切口愈合不良行清创后重新缝合,其余患者无并发症发生。结论跟腱止点病的手术治疗不仅要去除跟腱腱体的病变,还要创造良好的腱周环境。拇长屈肌腱转位技术治疗顽固性跟腱止点病可获得满意的疗效。     

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。     

Flexor hallucis longus transfer for chronic Achilles tendonosis

A technique similar to the one described by Hansen for reconstruction of chronic Achilles tendinosis using the flexor hallucis longus (FHL) tendon was used in 26 patients (29 tendons). Follow-up on all 26 patients (mean age 51.3 years) is provided with an average follow-up 35 months (range, 12 to 58 months). All patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. The AOFAS Foot Ratios for the ankle and hindfoot (total of 100 points) was used. Time to maximum improvement was 8.2 months (range, three to 20 months). Ankle-Hindfoot Scale ratings improved from 41.7 (range, 23 to 63) preoperatively to 90.1 (range, 49 to 100) postoperatively. All but three patients evaluated their result as good or excellent in regards to improved function and pain. No patient had a significant functional deficit or deformity of the hallux after transfer of the FHL tendon.     

Hypertrophy of the flexor hallucis longus muscle after tendon transfer in patients with chronic Achilles tendon rupture

BackgroundFlexor hallucis longus tendon (FHLT) transfer has become a popular method for reconstructing a chronic Achilles tendon rupture (ATR). The purpose of this study was to evaluate the clinical outcomes and possible hypertrophy of the FHL muscle after FHLT transfer in patients with chronic ATR.MethodsSeven patients with chronic ATR underwent an FHLT transfer to heel through single incision. The patients were clinically evaluated 27 (16–39) months after the surgery. The patient satisfaction was assessed with Achilles Tendon Total Rupture Scale (ATRS). Isokinetic strength was measured from both legs. The FHL muscle hypertrophy was evaluated from MRI of both legs. All subjects also performed a gait analysis with an instrumented walkway system (GAITRite^®).ResultsThe plantar flexion strength was 16.1% (-45, 7-2, 4%) weaker in the operated leg. ATRS scores averaged 70.3. Marked hypertrophy, +52% (9–104%) of the FHL muscle was seen in the operated leg compared to the non-operated leg. The gait analysis did not show any marked pathology in any of the patients.ConclusionsA mean hypertrophy of 52% of the FHL muscle was found after FHLT transfer for the chronic ATR. This indicates strong adaptation capacity of this muscle after FLHT transfer in situation where the function of the gastro-soleus complex was severely impaired preoperatively. The reconstruction of chronic ATR with FHLT transfer provided a good functional outcome and excellent patient satisfaction.     

Achilles allograft reconstruction of a chronic patellar tendon rupture

Chronic ruptures of the patellar tendon are uncommon injuries. They are technically difficult to repair because of scar formation, poor quality of the remaining tendon, and quadriceps muscle atrophy and contracture. We report the reconstruction of a chronic patellar tendon rupture with an interesting complication, a tibial stress fracture. The reconstruction was performed 3 months after the injury using an Achilles tendon-bone allograft and reinforcing suprapatellar wire. At 2 weeks postoperatively, the patient had attained full extension and 90 degrees of flexion. Ten months after the index procedure, the patient had range of motion 0 degrees to 120 degrees and was diagnosed with a healing tibial stress fracture. At 17 months postoperatively, the patient had attained full extension, 120 degrees of flexion, and 85% quadriceps strength. The preoperative goals of attaining full range of motion, improving quadriceps strength, obtaining anatomic patellar alignment, and restoring function were obtained despite the complication of a tibial stress fracture. Although this reconstructive procedure is technically demanding, with potential complications, the functional results obtained can be excellent.Arthroscopy 1998 Apr;14(3):340-4     

Endoscopic reconstruction for chronic Achilles tendon ruptures using a hamstring tendon autograft

BackgroundTo determine the safety and efficacy of endoscopic reconstruction of chronic Achilles tendon ruptures using a hamstring tendon autograft at mid-term follow-up.MethodsWe reviewed the medical records of patients with chronic Achilles tendon rupture treated surgically by endoscopic reconstruction using a hamstring tendon autograft at our institution between March 2010 and October 2015. Radiologic outcomes were assessed using pre- and postoperative magnetic resonance imaging (MRI). Functional outcomes were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Scale, the Plantar Flexion Strength (PFS), the Victorian Institute of Sport Assessment-Achilles (VISA-A) scale, the Visual Analogue Scale (VAS) pain score, and the Arner-Lindholm standard. All patients achieved primary healing with no lengthening of the Achilles tendon, skin necrosis, infection, deep vein thrombosis or other complications.ResultsMean follow-up period was 15 ± 3 months (range, 12–18 months). There was no Achilles tendon re-rupture. MRI examination revealed that Achilles tendon continuity was restored. Patients’ mean AOFAS, PFS, and VISA-A scores were significantly higher and mean VAS pain score was significantly lower after surgery compared to before (P < 0.05). According to Arner-Lindholm standards, there were twenty (76.9%) excellent, six (23.1%) good, and zero bad outcomes.ConclusionEndoscopic reconstruction utilizing a hamstring tendon autograft is a safe and efficacious option for repair of chronic Achilles tendon ruptures. Studies with larger sample sizes and a longer follow-up are required to confirm the advantage of this technique compared to open surgery.     

A Combined Repair Technique for Early Neglected Achilles Tendon Ruptures

Abstract Objective: This study presents the long-term results of a combined technique, using both Duthie's biological repair and a plantaris tendon transfer for the reconstruction of early neglected tendo Achilles ruptures. Materials and Method: Between January 2000 and November 2004, nine patients with an early neglected Achilles tendon rupture (≥ 4 and ≤ 12 weeks from injury), underwent surgical reconstruction. Eight patients were male and one female, their age was average 41 years and the median follow-up period was 3.66 years. The average clinical defect of the Achilles tendon was 4.33 cm. Results: All patients were examined by the clinical ankle scoring system of Leppilahti et al. (Clin Orthop 346:152–161, 1998). Six patients presented excellent results and three patients had good results. All patients had equal plantarflexion and dorsiflexion with the healthy side and all of the study's patients returned to work 3 months postoperatively. An average muscle atrophy of 0.83 cm was documented compared with the uninjured side. Only four of nine patients (44.44%) had a normal one-legged jump. There were no complications postoperatively and no re-ruptures of the Achilles tendons. Conclusion: This combined method appears to be safe and effective, with a low risk for complications, allowing us to obtain excellent results for the majority of our patients.