跟腱断裂合并跟腱末端病变的手术治疗Surgical treatment of Achilles tendon rupture accompanied with Achilles enthesopathy
魏驰;余黎;邓玲珑;屈文强;祝少博;
摘要(Abstract):
[目的]介绍跟骨结节切除带线铆钉止点重建术治疗跟腱断裂合并跟腱末端病变的手术技术。[方法]7例跟腱断裂合并跟腱末端病变患者采用跟骨结节及变性跟腱切除、带线铆钉止点重建术。术中切除足够大的跟骨骨块,切除变性坏死跟腱,对于缺损较小者(<2 cm)直接行带线铆钉缝合固定于跟骨,缺损较大者(>2 cm)采取腓肠肌腱V-Y延长技术及自体肌腱移植来恢复跟腱长度和维持后期踝关节功能。延长跟腱,带线铆钉跟腱止点重建,术后石膏固定4周。[结果]术后1例切口出现红肿,经伤口换药、升级抗生素后愈合。7例获6个月~2年随访,采用Arner-Lindholm评分标准,临床结果评定为优6足,良1足。所有患者踝关节背伸跖屈功能正常。[结论]跟骨结节及变性跟腱切除、带线铆钉止点重建术治疗跟腱断裂合并跟腱末端病具有较好的临床疗效,术中细致操作、足够大的骨块切除、变性坏死跟腱的切除、带线铆钉止点重建等是手术成功的关键。
关键词(KeyWords): 跟腱断裂;跟腱末端病变;带线铆钉
基金项目(Foundation): 湖北省卫生计生委面上项目(编号:WJ2017M030)
作者(Author): 魏驰;余黎;邓玲珑;屈文强;祝少博;
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DOI:
参考文献(References):
- [1]桂鉴超,顾湘杰.王旭,等.跟腱末端病的诊断及手术治疗[J].中华骨科杂志,2007,27(6):413.
- [2]Lu CC,Cheng YM,Fu YC,et al.Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification[J].Foot Ankle Int,2007,28(2):181-185.
- [3]陈明法,任国良,姚作宾.跟腱微血管解剖及其临床意义[J].中国临床解剖志,1994,12(2):85.
- [4]Hu JJ,Yin Z,Shen WL,et al.Pharmacological regulation of in situ tissue stem cells differentiation for soft tissue calcification treatment[J].Stem Cells,2016,34(4):1083-1096.
- [5]Myerson MS.Achilles tendon ruptures[J].Instr Course Lect,1999,48(2):219-230.
- [6]Jiang N,Wang B,Chen A,et al.Operative versus nonoperative treatment for acute Achilles tendon rupture:a meta-analysis based on current evidence[J].Int Orthop,2012,36(4):765-773.
- [7]Neufeld SK,Farber DC.Tendon transfers in the treatment of Achilles’tendon disorders[J].Foot Ankle Clin,2014,19(1):73-86.
- [8]Us AK,Bilgin SS,Aydin T,et al.Repair of neglected achilles tendon ruptures:procedures and functional results[J].Arch Orthop Trauma Surg,1997,116(6-7):408-411.
- [9]Maffulli N,Spiezia F,Testa V,et al.Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon[J].J Bone Joint Surg Am,2012,94(10):906-910.
- [10]Lins C,Ninomya AF,Bittar CK,et al.Kinetic and kinematic evaluation of the ankle joint after achilles tendon reconstruction with free semitendinosus tendon graft:preliminary results[J].Artif Organs,2013,37(3):291-297.
- [11]Maffulli N,Spiezia F,Longo UG,et al.Less-invasive reconstruction of chronic achilles tendon ruptures using a peroneus brevis tendon transfer[J].Am J Sports Med,2010,38(11):2304-2312.
- [12]Maffulli N,Oliva F,Costa V,et al.The management of chronic rupture of the Achilles tendon:minimally invasive peroneus brevis tendon transfer[J].Bone Joint J,2015,97-B(3):353-357.
- [13]Ferris L,Sharkey NA,Smith TS,et al.Influence of extrinsic plantar flexors on forefoot loading during heel rise[J].Foot Ankle Int,1995,16(8):464-473.
- [14]Jacob HA.Forces acting in the forefoot during normal gait--an estimate[J].Clin Biomech(Bristol,Avon),2001,16(9):783-792.
- [15]Wegrzyn J,Luciani JF,Philippot R,et al.Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer[J].Int Orthop,2010,34(8):1187-1192.
- [16]Richardson DR,Willers J,Cohen BE,et al.Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer[J].Foot Ankle Int,2009,30(7):627-630.
- [17]Khazen GE,Wilson AN,Ashfaq S,et al.Fixation of calcaneal avulsion fractures using screws with and without suture anchors:a biomechanical investigation[J].Foot Ankle Int,2007,28(11):1183-1186.
- [18]Seeger JD,West WA,Fife D,et al.Achilles tendon rapture and its aasociation with fluoroquinolone antibiotics and other potential risk factors in a managed care population[J].Pharmacoepidemiol Drug Saf,2006,15(11):784-792.