陈旧性跟腱断裂V-Y腱成形术的实验研究与临床应用

目的为陈旧性跟腱断裂V-Y腱成形术的临床应用提供实验依据,从而达到推广此手术方式的目的。方法用73只新西兰白兔,建立陈旧性跟腱断裂模型后行V-Y腱成形术和Lindholm术,术后分别行组织学观察和生物力学测试。对平均135d的12例陈旧性跟腱断裂患者行V-Y腱成形术后,行X线、B超等影像学检查,随访时间1年10个月～11年,平均6年5个月,并用Arner-Lindholm疗效评定标准进行评定。结果(1)实验研究发现,V-Y腱成形术对跟腱血运无明显影响,组织学修复好,术后生物力学性能恢复优于Lindholm术。(2)按Arner-Lindholm疗效评定标准,优10例(83.3%),良2例(16.7%),优良率达100%。(3)术后X线、B超检查显示跟腱普遍增粗,腱纤维排列已趋于正常,2例患者有跟腱钙化。结论根据实验和临床研究结果表明,V-Y腱成形术疗效佳,可以作为治疗陈旧性跟腱断裂的首选术式。

V-Y tendoplasty for treatment of chronic achilles tendon rupture: clinical and experimental studies

Objective To provide clinical and experimental basis for the V-Y tendoplasty for the treatment of chronic achilles tendon rupture and describe the surgical techniques. Methods Seventy-three NewZealand white rabbits, in which chronic achilles tendon rupture model were established previouly, were treated with V-Y tendoplasty and Lindholm procedure. Postoperative histological studies and biomechanical test were carried out. Twelve patients who had a torn achilles tendon for an average of 135 days were treated with V-Y tendoplasty. The mean period of follow up was 6.5 years. The long term result was assessed with Arner-Lindholm method and radiological, ultrasonic examination were also performed. Results 1)The experimental studies showed that blood circulation of achilles tendon were not affected after the V-Y tendoplasty. The postoperative biomechanical characteristics of achilles tendon were more favorable than that of Lindholm procedure's. 2)According to Arner-Lindholm criteria 10 patients had the excellent results (83.3%), 2 patients had good results (16.7%). The percentage of excellent and good results were 100%. 3)The postoperative radiological and ultrasonic test results showed that there was overall thickening of whole achilles tendon. The array of tendon fibres was nearly normal. Calcification of achilles tendon were found in 2 patients. Conclusion V-Y tendoplasty might be a procedure of choice to treat chronic achilles tendon rupture.