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。     

陈旧性跟腱断裂的治疗与康复

陈旧性跟腱断裂目前的治疗方法均采用手术修复,但手术修复的方法和术后的固定、功能锻炼存在着差异与分歧,我们对31例陈旧性跟腱断裂患者的治疗进行了回顾.     

钢丝Bunnel缝合法治疗跟腱断裂

跟腱断裂是临床较常见的一种运动性损伤。我院自1998年6月～2003年6月采用钢丝Bunnel缝合法治疗急性跟腱断裂18例20侧，效果良好，报告如下。     

跟腱断裂修复术后并发症的探讨

跟腱断裂是一种较为常见的损伤,由于非手术治疗效果不确定,因而对跟腱断裂的治疗以手术治疗为主[1].但术式选择或操作不当可能会引起较多的并发症[2、3],从而影响疗效及功能恢复.我科1992年3月～2002年4月共施行跟腱断裂修复术102例,其中出现并发症者15例,占14.7%.经适当治疗后,取得较为满意的疗效,报告如下.     

带孔钢针微创Bunnell缝合治疗新鲜闭合性跟腱断裂

[目的]探讨应用带孔钢针微创Bunnell缝合法治疗新鲜跟腱断裂的临床疗效.[方法]回顾性分析2007年1月～ 2010年12月采用带孔钢针微创Bunnell缝合法(微创组)52例及传统切开手术(切开组)31例并获得随访的新鲜跟腱断裂患者资料.观察两组手术时间、术中出血量、切口愈合时间、切口并发症、跟腱再断裂、优良率、末次随访AOFOS评分等指标.[结果]所有患者随访12 ～ 16个月,平均13.6个月.两组跟腱再断裂、优良率、末次随访AOFOS评分组间比较无显著性意义(P＞0.05).微创组手术时间、切口愈合时间均短于单侧组(P＜0.05),微创组术中出血量、切口并发症均少于单侧组(P＜0.05).[结论]应用带孔钢针微创Bunnell缝合法治疗新鲜跟腱断裂与传统手术方法效果相似,但前者具有手术时间短、创伤小、切口并发症少等优点.     

缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂

目的探讨缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂的临床疗效。方法自2007-11—2012-09采用缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂29例,术后6个月依据Arner-Lindholm评分和AOFAS评分标准评定疗效。结果本组手术时间25~52 min,平均52 min。切口均一期愈合。所有患者均获得平均11.3(7~19)个月随访,无跟腱再次断裂、跟腱粘连等并发症发生。随访至术后6个月时,按照Arner-Lindholm评分标准评定临床疗效:优20例,良9例;采用美国足踝外科学会(AOFAS)踝-足评分标准进行功能评价:优19例,良10例,平均92.3分。结论缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂具有操作简单、肌腱修复可靠、踝关节功能恢复好的优点。     

传统与微创缝合急性闭合性跟腱断裂的比较

[目的]比较传统与微创缝合术治疗修复急性闭合性跟腱断裂的临床效果.[方法] 2016年5月-2019年11月,对64例(64足)急性闭合性跟腱断裂患者行手术缝合修复术.依据术前医患沟通结果,30例行传统切开缝合术,34例行通道辅助微创修复系统(channel-assisted minimally invasive re...     

Krackow缝合法治疗新鲜撕裂型跟腱断裂

目的总结新鲜撕裂型跟腱断裂的治疗方法及疗效。方法分析19例新鲜闭合撕裂型跟腱断裂采用Krackow法缝合修复的治疗过程及对策。结果本组病例术后疗效优14例，良5例，其中1例跟腱与皮肤有黏连。随访期内无跟腱再断裂及深部感染等并发症。结论新鲜撕裂型跟腱断裂的手术治疗采用Krackow缝合法修复是一个比较安全、有效的方法。     

Bilateral Cadaveric Achilles Tendon Graft in Reconstruction after Achilles Tendon Tumor Resection

The standard approach to reconstruction after resection of a diffuse-type tenosynovial giant cell tumor is a local patch with free flaps. However, in cases in which the Achilles tendon involvement is extensive, and the entire tendon must be removed, an autologous flap graft might not be adequate to allow a return to function. We report a case of a 52-year-old female patient who developed bilateral tumors of the Achilles tendon, with a 10-year duration. By the time, she sought medical help, both Achilles tendons required removal. We chose to use Achilles tendon allografts to replace the Achilles tendons. Postoperatively, the patient did well. The allograft shortened the recovery time, and the patient regained full ankle range of motion.     

Achilles Tendon Reconstruction after Sural Fasciocutaneous Flap Using Achilles Tendon Allograft with Attached Calcaneal Bone Block

Addressing segmental loss of the Achilles tendon with overlying soft tissue loss is a serious challenge. We present a case of Achilles tendon reconstruction in a patient who had significant soft tissue loss as well as segmental loss of the tendon involving the calcaneal insertion. The staged reconstruction was undertaken with a combination of a sural fasciocutaneous flap and an Achilles tendon allograft with an attached calcaneal bone block.     

Incidence of Symptomatic Deep Venous Thrombosis after Achilles Tendon Rupture

Deep venous thrombosis (DVT) is a significant source of morbidity and mortality and is associated with many orthopedic procedures. Previous studies have reported highly variable DVT rates in patients with Achilles tendon rupture undergoing operative and nonoperative treatment. We performed a retrospective chart review for all patients who underwent Achilles tendon repair at our institution from January 2006 to February 2012. Patient data were collected from the electronic medical record system. A total of 115 patients were eligible for the present study. Of these patients, 27 (23.47%) with a surgically treated Achilles tendon rupture developed a symptomatic DVT either while waiting for, or after, surgical intervention, with approximately one third of these diagnosed before surgical intervention. Of the 27 patients with DVT, 3 had a proximal DVT and 24 had a distal DVT. One patient developed a pulmonary embolism. The DVT incidence was greater in the 2 older age groups (40 to 59 and 60 to 79 years) compared individually with the younger age group (20 to 39 years; p < .0026 and p < .0014, respectively). We have shown a high incidence of DVT after Achilles tendon rupture. We recommend a high level of suspicion for the signs and symptoms of DVT during the follow-up period. In addition, patient education and early mobilization should be advocated, especially for patients older than 40 years. Additional randomized controlled trials investigating any benefits to pharmaceutical DVT prophylaxis in this population are needed to establish evidence-based recommendations.