自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的疗效观察_《中国修复重建外科杂志》

作者：

齐进 , 夏亚一 , 汪玉良 , 赵琳 , 姚长江

兰州大学第二医院骨科（兰州，730030）;

关键词：

跟腱缺损腘绳肌腱（足母）长屈肌腱跟腱重建

DOI：

10.7507/1002-1892.20130263

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的临床疗效。方法2009年2月－2011年10月，采用自体腘绳肌腱联合（足母）长屈肌腱转移重建9例9足跟腱缺损。男6例，女3例；年龄21～65岁，平均43岁。其中运动伤导致陈旧性跟腱断裂伴缺损5例；跟腱病变切除后跟腱缺损4例，其中跟腱纤维玻璃样变伴坏死2例、跟腱巨细胞瘤1例、跟腱慢性炎症伴玻璃样变1例。病程31～387 d，平均137.6 d。跟腱缺损长度为5～18 cm，平均8.6 cm。术后踝关节石膏固定6周后开始功能锻炼。结果术后2例发生切口裂开、渗液，1例出现胫神经损伤导致的足底疼痛；余患者切口均Ⅰ期愈合，无相关并发症发生。9例患者均获随访，随访时间13～25个月，平均19.7个月。随访期间均无重建肌腱断裂发生。术后1年及末次随访时踝关节背伸活动度与术前比较差异无统计学意义（P gt; 0.05），踝关节跖屈活动度均显著大于术前（P lt; 0.05）。术后1年及末次随访时踝关节跖屈、背伸活动度均显著大于术后3个月（P lt; 0.05），末次随访时与术后1年比较差异均无统计学意义（P gt; 0.05）。患者术后美国矫形足踝协会（AOFAS）及简明健康调查量表（SF-36量表）评分均较术前显著提高，且末次随访时评分显著高于术后3个月时，差异均有统计学意义（P lt; 0.05）。末次随访时，跟腱修复术后临床疗效评分（ATRS）亦显著高于3个月时，差异有统计学意义（t= —7.982，P=0.000）。结论自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱疗效确切。

引用本文： 齐进,夏亚一,汪玉良,赵琳,姚长江. 自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的疗效观察. 中国修复重建外科杂志, 2013, 27(10): 1202-1205. doi: 10.7507/1002-1892.20130263 复制

1.	16 苗旭东, 吴永平, 陶惠民, 等. 微创切取长屈肌腱重建慢性跟腱断裂. 中国修复重建外科杂志, 2011, 25(7): 796-799.
2.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3.	Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon Total Rupture Score (ARTS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
4.	Yeoman TF, Brown MJ, Pillai A. Early post-operative results of neglected tendo-Achilles ruputure reconstruction using short flexor hallucis longus tendon transfer: a prospective review. Foot (Edinb), 2012, 22(3): 219-223.
5.	Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int, 2006, 27(11): 952-959.
6.	Den Hartog BD. Surgical strategies: delayed diagnosis or neglected Achilles’ tendon ruptures. Foot Ankle Int, 2008, 29(4): 456-463.
7.	Hahn F, Maiwald C, Horstmann T, et al. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus longus transfer. Chin Biomech (Bristol, Avon), 2008, 23(1): 109-116.
8.	Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg (Br), 1985, 67(3): 432-437.
9.	Hahn F, Meyer P, Maiwald C, et al. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot ankle Int, 2008, 29(8): 794-802.
10.	Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop, 2010, 34(8): 1187-1192.
11.	Richardson DR, Willers J, Cohen BE, et al. Evaluation of the hallux morbidity of single-incison flexor hallucis longus tendon transfer. Foot Ankle Int, 2009, 30(7): 627-630.
12.	Coull R, Flavin R, Stephens MM. Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int, 2003, 24(12): 931-934.
13.	Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med, 1993, 12(4): 723-756.
14.	Lee YS, Min BH, Han KJ, et al. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture. Orthopedics, 2010, 33(5): 329-331.
15.	俞光荣, 庞清江, 余霄, 等. 跟骨结节撕脱骨折的手术治疗. 中华骨科杂志, 2013, 33(4): 320-325.
16.	Chappard C, Brunet-Imbault B, Lemineur G, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int, 2005, 16(10): 1193-1202.
17.	Rigby RB, Cottom JM, Vora A. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg, 2013. [Epub ahead of print].

1. 16 苗旭东, 吴永平, 陶惠民, 等. 微创切取长屈肌腱重建慢性跟腱断裂. 中国修复重建外科杂志, 2011, 25(7): 796-799.
2. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3. Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon Total Rupture Score (ARTS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
4. Yeoman TF, Brown MJ, Pillai A. Early post-operative results of neglected tendo-Achilles ruputure reconstruction using short flexor hallucis longus tendon transfer: a prospective review. Foot (Edinb), 2012, 22(3): 219-223.
5. Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int, 2006, 27(11): 952-959.
6. Den Hartog BD. Surgical strategies: delayed diagnosis or neglected Achilles’ tendon ruptures. Foot Ankle Int, 2008, 29(4): 456-463.
7. Hahn F, Maiwald C, Horstmann T, et al. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus longus transfer. Chin Biomech (Bristol, Avon), 2008, 23(1): 109-116.
8. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg (Br), 1985, 67(3): 432-437.
9. Hahn F, Meyer P, Maiwald C, et al. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot ankle Int, 2008, 29(8): 794-802.
10. Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop, 2010, 34(8): 1187-1192.
11. Richardson DR, Willers J, Cohen BE, et al. Evaluation of the hallux morbidity of single-incison flexor hallucis longus tendon transfer. Foot Ankle Int, 2009, 30(7): 627-630.
12. Coull R, Flavin R, Stephens MM. Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int, 2003, 24(12): 931-934.
13. Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. Clin Sports Med, 1993, 12(4): 723-756.
14. Lee YS, Min BH, Han KJ, et al. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture. Orthopedics, 2010, 33(5): 329-331.
15. 俞光荣, 庞清江, 余霄, 等. 跟骨结节撕脱骨折的手术治疗. 中华骨科杂志, 2013, 33(4): 320-325.
16. Chappard C, Brunet-Imbault B, Lemineur G, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int, 2005, 16(10): 1193-1202.
17. Rigby RB, Cottom JM, Vora A. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg, 2013. [Epub ahead of print].

《中国修复重建外科杂志》

自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的疗效观察

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《中国修复重建外科杂志》

自体腘绳肌腱联合（足母）长屈肌腱转移重建跟腱的疗效观察

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