胫后肌两种移位术式矫治麻风垂足的远期疗效

目的 分析胫后肌移位术矫正麻风致垂足的远期疗效和并发症，并比较皮下法和经骨间膜法不同肌腱路径及不同肌腱止点的远期效果。方法 2001年1～10月对近10年的37例患者进行家庭随访。对患者的步态、踝关节的主动背屈和跖屈、移位肌肌力变化、足部畸形和溃疡发生情况以及患者对手术疗效的评价等进行检查和记录，综合评定手术疗效。结果 胫后肌移位术经皮下隧道法22例，经骨间膜法15例；肌腱止于骨孔9例，其余均止于肌腱。所有患者均行跟随延长。手术总优良率达86％。经骨间膜法的主动背屈功能优于皮下隧道法。获得随访时间35例(1例失访，1例死于肿瘤)，随访时间2～11年，平均4年。有14例出现轻度足内翻，主要发生在经皮下隧道的患者；与经骨间膜法的13例中仅出现2例相比较，二者差异有显著性(P＜0．05)。其中并发症：垂趾5例；小腿肌肉萎缩4例；肌腱吻合处断裂与肌腱粘连各1例。结论 胫后肌移位术矫正垂足可获优良的远期效果，应尽量采用经骨间膜法胫后肌移位术以避免术后并发足内翻。

A LONG-TERM FOLLOW-UP RESULT OF POSTERIOR TIBIALIS MUSCLE TRANSFER FOR FOOT-DROP IN LEPROSY PATIENTS

Objective To determine the long-term results and possible complications of the posterior tibialis transfer in correction of the foot-drop in leprosy patients, and to compare the results by the circumibibial and interosseous routes. Methods From January to October 2001, 37 cases ( treated from October 1989 to October 1999) were followed up. Walking gait, active dorsiflexion and plantar flexion of the ankle joint, deformities of the feet, and patients' satisfaction were recorded. Results Of 37 patients, 22 were treated by circumtibial transfer, 15 by interosseous transfer. All patients' Achilles tendons were lengthened. Excellent and good results were obtained in 30 cases(86%). The active dorsiflexion was better by interosseous route than by circumtibial route. Out of 35 patients followed up for 2-11 years(4 years on average), 14 had talipes varus in 22 by circumtibial transfer, 2 had talipes varus in 13 by interosseous transfer; there was significant difference between two routes( P< 0.05). The complications included drop-toe(5 cases), muscle atrophy (4 cases), tendon rupture (1 case) and tendon adhesion( 1 case). Conclusion Tibialis posterior transfer with elongation of tendo Achillis can obtain excellent results in treating foot-drop due to leprosy. Interosseous route is preferred and physiotherapy is emphasized pre- and postoperatively.