新式跟腱延长术治疗儿童马蹄足

目的 介绍一种新式跟腱延长术治疗儿童马蹄足的手术方法和要点,并观察术后疗效.方法 对2002年1月至2007年12月收治的19例(23足)儿童马蹄足患者采用跟腱矢状位3份切断交错滑移的方法进行跟腱延长,术后小腿石膏固定踝关节于背伸90°位2周,2周后开始全负重功能锻炼.于术前、术后短期及术后中期随访测量患足背伸角度,并行Corry修正步态医师等级量表评分(PRS).结果 本组17例(20足)获得随访,时间为1～5年(平均3.5年).结果 显示患者均能在2周后全部负重功能锻炼、患足踝关节角度从术前平均116.1°±15.0°下降到术后短期随访时的68.5°±9.6°及中期随访时的71.3°±8.5°,术前与术后比较差异有统计学意义(P<0.05).PRS中的膝反曲、足着地方式、总体改变指标术前与术后比较差异均有统计学意义(P<0.05),蹲伏差异无统计学意义(P>0.05).本组患者未出现跟腱断裂、跟行足等并发症.结论 新式跟腱延长术能增进跟腱的强度、满足延长长度、达到早期功能锻炼的目的并促进功能快速恢复,是一种有效的跟腱延长术式.

A new Achilles tendon lengthening for treatment of equinus in children

Objective To introduce a self-modified Achilles tendon lengthening (ATL) for treatment of equinus deformity in children. Methods From January 2002 to December 2007, we treated 23 feet of 19 children patients with a self-modified ATL. In the procedure, the Achilles tendon was dissected sagittally into strands A, B and C and cut respectively at the posterior 1/4, middle 2/4 and anterior 1/4. The tendon was finally woven and sutured by anastomosing B2 with Aland C1 with B2. Postoperative physical therapy included below-knee cast immobilization with the ankle at 90° of dorsiflexion for 2 weeks. Immediate weightbearing was allowed 2 weeks after below-knee east Immobilization. The angle of ankle dorsiflexion and Corry physician rating scale (PRS) were measured at preoperation, immediate postoperation and medium-term postoperation. Results All the 20 feet obtained follow-up ranging from 1 to 5 years. All the patients could perform functional rehabilitation with compleze weightbearing 2 weeks postoperatively. The dorsiflexion of the foot improved obviously from preoperative 116. 1°± 15.0°to 68.5°±9.6°at immediate postoperation and 71.3°± 8.5° at medium-term postoperation ( P < 0. 05). The knee recurvatum, foot contact and total sc ores in PRS improved significantly from preoperation to postoperation ( P < 0. 05) . However, the couch score was unchanged( P > 0. 05) . No complications such as rupture and heel gait were observed in our study.Conclusion The self-modified ATL is a good surgical procedure which can enhance the stability of the lengthened Achilles tendon and facilitate functional recovery.