Brunner R, Jaspers R T, Pel J J, Huijing P A
Department of Orthopedics, University Basel, Children's Hospital, Switzerland.
Clin Orthop Relat Res. 2000 Sep(378):264-73. doi: 10.1097/00003086-200009000-00037.
Intramuscular aponeurotic lengthening of muscles or intramuscular tenotomy involves bisecting the connective tissue fibers of the aponeurosis or tendon within the muscle belly. Because of its superficial location in the muscle, the aponeurosis may be bisected without damaging muscle fibers. Despite the existence of common operative methods for gaining length in short muscles, the effects on force and muscle function have not been studied. For this purpose animal experiments were performed. The medial gastrocnemius muscle of six male Wistar rats was lengthened by cutting the proximal aponeurosis at 50% of its length perpendicularly to the collagen fibers. The length gain was maintained by 3 days of cast immobilization at maximal dorsiflexion of the ankle. The long-term effect of the treatment was studied after 6 weeks and compared with 10 untreated controls and with six sham operated animals. The muscle was isolated in situ, and the force length characteristics were determined. In the untreated controls, the aponeurotomy was performed and the length force experiment was repeated to study the acute effects. The aponeurotic lengthening led acutely to a temporary loss of force because of an incomplete connection of the distal part of the muscle to the proximal insertion, but force recovered completely within 6 weeks. Although results from animal experiments cannot be transferred directly to humans, the principles of physiology are similar. Thus, for clinical use, aponeurotic lengthening should be considered if muscle force needs to be preserved. However, the drop of muscle force after surgery must be respected when mobilizing the patient during the postoperative rehabilitation program.
肌肉内腱膜延长术或肌肉内腱切断术是指将肌腹内腱膜或肌腱的结缔组织纤维一分为二。由于腱膜位于肌肉表层，因此在不损伤肌纤维的情况下即可将其切断。尽管存在多种用于延长短肌长度的常用手术方法，但尚未对其对肌力和肌肉功能的影响进行研究。为此进行了动物实验。将六只雄性Wistar大鼠的内侧腓肠肌通过在其近端腱膜长度的50%处垂直于胶原纤维进行切断来延长。通过在踝关节最大背屈位进行3天的石膏固定来维持长度增加。在6周后研究该治疗的长期效果，并与10只未治疗的对照动物以及6只假手术动物进行比较。在原位分离肌肉，并测定其力-长度特性。在未治疗的对照动物中，进行腱膜切断术并重复力-长度实验以研究急性效应。腱膜延长术会因肌肉远端与近端附着点的连接不完全而急性导致暂时的肌力丧失，但肌力在6周内完全恢复。尽管动物实验的结果不能直接应用于人类，但生理原理是相似的。因此，在临床应用中，如果需要保留肌肉力量，应考虑腱膜延长术。然而，在术后康复计划中动员患者时，必须考虑到手术后肌力下降的情况。
