【摘要】 目的探讨胫后肌腱功能障碍的手术治疗方法。方法2002年12月至2005年6月,手术治疗8例单侧胫后肌腱功能不良患者,男2例,女6例;年龄36～56岁,平均47岁。左足6例,右足2例;胫后肌腱功能不良Ⅱ期2例,Ⅲ期6例。根据Maryland足部评分标准,术前足踝功能为可2例、差6例。对每例患者设计个体化手术方案,联合应用足外侧柱延长术、关节融合术、胫后肌腱修复术、弹簧韧带紧缩术及趾长屈肌腱转移术等术式。骨性手术一般辅以一种以上相关的软组织手术,其中4例行胫后肌腱前移加强术,2例行弹簧韧带紧缩术,4例行趾长屈肌腱转移术。术后以短腿管型石膏将患足固定于内翻跖屈位,4～6周后改用短腿后托石膏将患足于中立位继续固定4周,拆除外固定后,根据骨愈合情况逐渐开始负重训练。结果全部病例均获得随访,随访时间12～40个月,平均28个月。根据Maryland足部评分标准,术后优4例、良3例、可1例,优良率为87.5%。所有患者术后足外形均恢复良好,能穿普通鞋。术后X线片测量的足弓高度及提示前足外展、后足外翻畸形矫正程度的特异性角度明显改善(P<0.01),其中弓高平均增加8mm,侧位距跟角平均减少14°,前后位距跟角平均减少12°,侧位第一跖距角平均减少17°,跟骨倾斜角平均增加11°,距舟覆盖角平均减少6°。结论骨性手术结合软组织手术组成的个体化联合术式治疗胫后肌腱功能不良可获得较理想的疗效。更多还原

【Abstract】 Objective To discuss the methods of the operative treatment for posterior tibial tendon dysfunction (PTTD). Methods From December 2002 to June 2005, 8 cases of PTTD were treated with operations, including 2 males and 6 females with an average age of 47 years (range, 36 to 56 years). Left side was involved in 6 cases, and right side was affected in 2 cases. Stage Ⅱposterior tibial tendon dysfunction were 2 feet and stage Ⅲ were 6 feet. Every case with special operative treatment, for instance lateral column lengthening, arthrodesis, repair posterior tibial tendon, spring ligament reefing, flexor digitorum longus tendon transfer and so on. Every bone operation was combined with one or more than one sofe tissue operation. Anterior transfer and strengthening of posterior tibial tendon were performed in 4 cases, spring ligament reefing in 2 cases, flexor digitorum longus tendon transfer in 4 cases. All patients were fixed with plaster cast at inversion position for 4-6 weeks, then changed to plaster splint fixing at neutral position for 4 weeks. Functions of ankle and foot were evaluated before and after operation. Results All patients were followed up for an average of 28 months(range, 12 to 40 months). According to Maryland foot score, 2 were fair and 6 were failure in preoperative, 4 were excellent, 3 were good and 1 was fair in postoperative. The total excellent and good rate was 87.5%. The specific index of X-ray improve obviously(P< 0.01). The height arch increased average 8 mm, the lateral talocalcaneal angle decreased 14°, the AP talocalcaneal angle decreased 12°, the lateral talar-1st metatarsal angle decreased 17°, the calcaneal inclination angle increased 11° and the talonavicular coverage angle decreased 6°. Conclusion The surgical treatment for PTTD should combine with special bone and soft tissues operation.更多还原