【摘要】 目的:探讨腓肠肌腱膜松解后跟腱断端瘢痕组织缝合治疗陈旧性跟腱断裂的临床疗效。方法:回顾性分析2017年1月至2019年12月收治的17例陈旧性跟腱断裂患者的临床资料,其中男15例,女2例,年龄26～53(35.2±11.6)岁,受伤至手术时间37～92(49.3±13.3) d。Myerson分型Ⅱ型6例,Ⅲ型11例。术中清除部分瘢痕组织后跟腱断端缺损2～5(4.1±1.5) cm。所有患者采用腓肠肌腱膜松解,跟腱断端瘢痕组织适当切除后直接缝合。术后3个月通过彩超评价跟腱的连续性及愈合情况,术前及术后1年采用踝关节跖屈力量检测仪检测踝关节跖屈肌力,术前及术后1年采用美国足踝外科协会踝-后足评分(American Orthopaedic Foot and Ankle Society ankle-hindfoot score,AOFAS)及跟腱断裂评分(Achilles tendon total rupture score,ATRS)评价跟腱断裂的临床康复情况。结果:所有患者获得随访,时间12～18(13.6±1.8)个月,手术切口均Ⅰ期愈合。彩超示跟腱连续性良好,局部跟腱略增粗,纤维方向不规则。术后1年踝关节跖屈肌力(92.2±3.9) N较术前(29.5±4.2) N明显增加(P<0.05);术后1年AOFAS评分(91.20±3.30)分较术前(42.20±4.40)分明显提高(P<0.05),其中优15例,良2例;术后1年ATRS评分(90.70±3.00)分较术前(40.00±2.90)分明显提高(P<0.05),其中优14例,良3例。结论:腓肠肌腱膜松解联合跟腱断端瘢痕组织缝合,避免损伤拇长屈肌或趾长屈肌,术后踝关节跖屈肌力恢复好,功能恢复满意,是治疗陈旧性跟腱断裂的有效方法之一。更多还原

【Abstract】 Objective:To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture.Methods:The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively,including 15 males and 2 females,aged 26 to 53 years with an average of(35.2±11.6) years old,and the time from injury to operation was37 to 92 days with an average of(49.3±13.3) days.Myerson’s classification included 6 cases of type Ⅱ and 11 cases of type Ⅲ.The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed.All patients were treated with gastrocnemius aponeurosis,appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture.The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation.The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation.American Orthopaedic Foot and Ankle Society ankle hindfoot score(AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score(ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture.Results:All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months.The surgical incision healed in stage Ⅰ,Color Doppler ultrasound showed good continuity of Achilles tendon,local Achilles tendon slightly thickened and irregular fiber direction.The ankle plantar flexor force(92.2±3.9) N at 1 year after operation was significantly higher than that before operation(29.5±4.2) N(P<0.05);One year after operation,the AOFAS(91.20±3.30) was significantly higher than that before operation(42.20±4.40)(P<0.05);the ATRS(90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05).Conclusion:The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture,avoid injury to hallux flexor longus or flexor digitorum longus,with the plantar flexor muscle strength of the ankle was recovered well,is an effective method to treat chronic Achilles tendon rupture.更多还原