应用(足母)长屈肌腱加用跖肌腱加固重建陈旧性跟腱断裂

1999年6月-2004年3月采用（足母）长屈肌腱（FHL）加用跖肌腱加固治疗陈旧性跟腱断裂13例,现报告如下。     

(足母)长屈肌腱转移重建慢性跟腱断裂

目的 探讨(足母)长屈肌腱转移联合界面钉固定重建慢性跟腱断裂的效果.方法 2004年10月-2007年6月,收治32例35足慢性跟腱断裂患者.男21例22足,女11例13足;年龄32～85岁.发病至手术时间为4～132 d.29例有患足用力蹬地史,3例无明显诱因.均有走路无力症状,Thompson试验阳性31例33足.美国足踝外科协会踝-后足疗效评价标准评分为(56.09±7.25)分.MRJ示跟腱断裂裂隙为0.5～5.0 cm.术中足内侧小切口联合跟内侧切口或直接跟内侧切口取(足母)屈肌腱,所切取近端(足母)长屈肌腱长度超过跟骨结节3 cm,界面钉于跟骨固定肌腱.结果 1例因伤口张力过大术后1周裂开,经对症处理后愈合;其余切口均Ⅰ期愈合.32例均获随访,随访时间12～32个月,平均19.4个月.术后12个月按照美国足踝外科协会踝-后足疗效评价标准评分为(94.22±4.63)分,与术前比较差异有统计学意义(P<0.01);优28例,良3例,可1例.无腓肠神经及胫后神经损伤、跖部痛性瘢痕、足底内外侧神经损伤.结论 (足母)长屈肌腱转移联合界面钉固定重建慢性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.     

拇长屈肌腱转移修复陈旧性跟腱断裂

2007年9月～2010年9月,我科采用拇长屈肌腱转移修复陈旧性跟腱断裂10例,效果满意,报道如下。1材料与方法1.1病例资料本组10例,男7例,女3例,年龄20～53岁。左侧4例,右侧6例。跟腱断裂部位:止点部断裂3例,腱     

微创切取长屈肌腱重建慢性跟腱断裂

目的探讨微创切取长屈肌腱转移重建慢性跟腱断裂的临床效果。方法 2006年7月-2009年12月,收治22例22足慢性跟腱断裂患者。男16例,女6例;年龄28～65岁,中位年龄48岁。21例有患足用力蹬地史,1例无明显诱因。患者出现症状至手术时间为27～1 025 d,中位时间51 d。均有走路无力症状,Thompson试验呈阳性。根据美国矫形足踝协会(AOFAS)踝与后足疗效评价标准评分为(53.04±6.75)分。MRI示跟腱缺损长度为4.2～8.0 cm。术中作中足足底内侧切口和趾间关节跖侧平行横纹的小切口分步切取长屈肌腱,切取长度为超过跟骨结节10.5～13.5 cm,作3束反折编织缝合。界面螺钉或锚钉于跟骨后结节固定肌腱。结果术后患者切口均Ⅰ期愈合,无早期并发症发生。22例均获随访,随访时间12～42个月,平均16.7个月。术后12个月根据AOFAS踝与后足疗效评价标准评分为(92.98±5.72)分,与术前比较差异有统计学意义(t=—40.903,P=0.000);获优18例,良2例,可2例,优良率90.9%。随访期间均未见胫、腓肠神经损伤、跖底部痛性瘢痕、足底内外侧神经损伤。结论微创切取长屈肌腱转移重建慢性跟腱断裂具有切口小、术后恢复快、肌腱固定强度高以及并发症少的优点。     

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。     

腓骨长肌腱和跖肌腱膜片修复陈旧性跟腱断裂

[目的]总结腓骨长肌腱和跖肌腱膜片治疗陈旧性跟腱断裂的方法和经验。[方法]将腓骨长肌止点处切断，经皮下遂道移位修复陈旧性跟腱断裂，跖肌腱膜片包绕缝合跟腱后侧形成光滑面。[结果]13例患者术后随访6个月-3年，获得了良好的疗效。[结论]腓骨长肌移位和跖肌腱膜片覆盖是治疗陈旧性跟腱断裂的一种有效方法。     

(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。     

腓骨长肌腱移位修复陈旧性跟腱断裂16例体会

跟腱断裂在小腿和足部肌腱损伤中较常见,陈旧性跟腱断裂手术修复较困难。笔者于2001年2月~2007年7月,利用腓骨长肌腱移位重建跟腱术治疗陈旧性跟腱断裂16例,取得满意效果。1临床资料1.1一般资料本组16例,男14例,女2例;年龄16~48岁。左侧4例,右侧12例;闭合性损伤15例,开放性1例;     

单切口与双切口长屈肌腱转位治疗陈旧性跟腱断裂的疗效比较

背景:单切口与双切口长屈肌腱(FHL)转位术可用于治疗跟腱大段缺损,但两种术式的临床疗效有待分析。目的:探讨单切口与双切口FHL转位术治疗KuwadaⅣ型陈旧性跟腱断裂的临床疗效。方法:回顾性分析2015年10月至2018年12月收治的KuwadaⅣ型陈旧性跟腱断裂患者28例(28足)。13例进行双切口FHL转位术治疗的作为双切口组,15例进行单切口FHL转位术治疗的作为单切口组。记录两组的手术时间、术后并发症,比较两组术前与末次随访的组内和两组间AOFAS-AH评分、Amer-Lindholm疗效评定标准与ATRS评分。结果:单切口组的手术时间为25~70 min,平均(56±12)min,明显短于双切口组的65~105 min,平均(86±11)min(P<0.05)。两组全部获得随访,随访时间为8~34个月,平均(16.6±6.2)个月。两组末次随访的疼痛、功能、总分均较术前有明显改善(P<0.01),术前和末次随访的两组间比较,差异无统计学意义(P>0.05)。末次随访时的Amer-Lindholm疗效评价:双切口组优8例,良5例;单切口组优12例,良3例,两组优良率均为100%。ATRS评分:两组末次随访的ATRS评分较术前有明显改善(P<0.01),术前和末次随访两组间比较,差异无统计学意义(P>0.05),患侧与健侧评分组内比较,差异无统计学意义(P>0.05)。双切口组中5例出现足底内侧神经损伤,通过保守治疗改善。结论:采用单切口与双切口FHL转位术治疗KuwadaⅣ型陈旧性跟腱断裂患者均可满意的短期疗效,单切口FHL转位术更为简单、合理、安全,更值得推荐。     

Scaphoid nonunion and flexor pollicis longus tendon rupture

Four patients presented with a rupture of the flexor pollicis longus tendon that was associated with a longstanding scaphoid nonunion. A radiocarpal arthrosis was present in 3 of the 4 patients and a dorsiflexed intercalated segment instability deformity was also seen in 3 of the 4 patients. Three patients underwent surgery consisting of an osteosynthesis with an iliac bone graft for the scaphoid nonunion and a palmaris longus tendon graft for the ruptured flexor pollicis longus tendon. An osseous union of the scaphoid and a functional active range of motion of the thumb interphalangeal joint (33 degrees on average) was attained in all 3 of the patients treated surgically. Preoperative radiologic examinations and intraoperative findings suggest that the volarly protruding distal scaphoid segment is the cause of the rupture.     

Spontaneous rupture of extensor pollicis longus tendon with tophaceous gout infiltration

Introduction Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported in the literature. Various mechanisms have been proposed to account for this problem, but gouty infiltration is a rare mechanism. Here we report a patient with a long-standing history of gout who presented with sudden loss of interphalangeal extension of the left thumb. Spontaneous rupture of the EPL tendon caused by gout was discovered.Materials and methods The successful treatment done involved surgical exploration and extensor indicis proprius tendon transfer. Postoperative thumb spica immobilization for 6 weeks was applied.Results Pathology disclosed urate crystals deposited within the ruptured EPL tendon. The functional recovery is satisfactory at the 1-year follow-up. Conclusion Spontaneous rupture of the EPL tendon caused by gout is rare. Successful treatment was done with surgical management. Life-long medical follow-up to prevent a repeated acute attack can lower the risk of a large amount of tophaceous gout infiltration in tendons and may possibly prevent acute spontaneous tendon rupture.     

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.     

经腕横韧带近侧切口显露拇长屈肌腱腕远侧断裂

拇长屈肌腱断裂后近端均有不同程度回缩,有时寻找极其困难.我们于1997年至今以经腕横韧带近侧切口肌腱向远侧递推法显露拇长屈肌腱近侧断端13例,效果满意,介绍如下.     

Duplicate extensor tendons of the thumb mimicking rupture of the extensor pollicis longus tendon

We report a patient with duplicate extensor pollicis longus tendons, who complained of inability to extend the thumb fully because of impingement of the musculotendinous junction of the duplicate tendons. Extension of the thumb recovered completely after Lister's tubercle was excised and the extensor retinaculum was released. Selective windowing with highlighting of the soft tissue in the axial T1‐weighted magnetic resonance image at the level of the distal radioulnar joint showed two tendons in the third extensor compartment.     

拇长屈肌腱断裂修复方法选择的探讨

[目的]介绍拇长屈肌腱断裂的治疗方法。[方法]共治疗拇长屈肌腱断裂15例，拇长屈肌腱断裂残端小于0．5cm，则给予切除，末节指骨钻孔钢丝缝合固定；肌腱断裂部位距掌指关节1cm以内，应用肌腱劈开延长，吻合口避开拇长屈肌腱鞘狭窄区；其余行直接吻接。[结果]所有病例均获得满意疗效，无术肌腱粘连和断离的发生。[结论]本方法修复肌腱获得了较好的效果，值得选用。     

The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures – A case control study

Background and aimVolar plating of distal radius fractures is one of the common procedures performed in trauma surgery. Flexor pollicis longus (FPL) rupture has been described as complication following volar plating of distal radius fractures.The aim of our study was to investigate the possible relation between parameters measured on post-operative radiographs and the occurrence of FPL ruptures.Materials and methodsThis was a case control study. The post-operative radiographs of 11 FPL rupture, and 22 non-FPL rupture patients were reviewed with respect to fracture reduction and plate position and the various parameters were calculated by five independent people.Logistic regression was used to examine the importance of the variables.ResultsWe identified two significant factors to predict FPL rupture after volar plating of distal radial fractures. These were radial tilt and plate distance from the joint line. The odds ratio of ruptures was 0.74 (95% CI 0.57–0.95) for every degree of radial tilt <25° and 0.50 (95% CI 0.28–0.88) for every millimetre that the distal end of the plate was away from the volar lip of the distal radius at the wrist joint.ConclusionPost-operative radiographs could help us predict FPL rupture after distal radius volar plating. The findings also highlight the need for good fracture reduction and thoughtful placement of the volar plate intraoperatively to minimise the risk of FPL tendon rupture.