趾长屈肌和胫后肌对Ⅱ期胫后肌腱功能障碍的肌腱转移和跟骨截骨术的反应。

The response of the flexor digitorum longus and posterior tibial muscles to tendon transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

作者信息

Rosenfeld Peter F, Dick Jonathan, Saxby Terence S

机构信息

St. Mary's Hospital, London, England.

出版信息

Foot Ankle Int. 2005 Sep;26(9):671-4. doi: 10.1177/107110070502600902.

DOI:10.1177/107110070502600902

PMID:16174495

Abstract

BACKGROUND

The purpose of this prospective study was to evaluate the response of the flexor digitorum longus (FDL) and posterior tibial (PT) muscles to FDL tendon transfer and medial displacement calcaneal osteotomy for stage II posterior tibial tendon dysfunction (PTTD).

METHODS

Twelve patients were divided into two groups, depending on whether the PT tendon was excised (Excised Tendon Group) or left intact (Intact Tendon Group). The muscle volumes of the FDL and PT muscles in both legs were measured and compared, using cross-sectional area (CSA) analysis of preoperative and postoperative MRI.

RESULTS

Preoperatively, there was an average 11% reduction in the PT muscle volume and a 17% increase in the FDL muscle volume from the normal contralateral side in both groups. One year after surgery (average 13.4 months) in both groups, the FDL muscle volume had increased by an average of 27% and the PT muscle volume had decreased by 23% compared to the contralateral normal side. The FDL volume increased by 44% in the Excised Tendon Group compared to 11% in the Intact Tendon Group. The PT muscle volumes were not assessed in the Excised Tendon Group because all PT muscle had been replaced by fatty infiltration. The PT volumes in the Intact Tendon Group decreased further from a 6% reduction preoperatively to a 23% reduction postoperatively compared to the normal contralateral side. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores increased from 50 preoperatively to 88 at 1 year after surgery. There was no difference in the scores between the Excised Tendon (47 to 87) and Intact Tendon (53 to 89) groups.

CONCLUSION

We concluded that the FDL muscle hypertrophies in response to a failing PT muscle. This hypertrophy continues after FDL transfer and medial displacement calcaneal osteotomy. With excision of the PT tendon, the FDL undergoes greater hypertrophy than if the tendon is left attached. The PT muscle continues to atrophy and undergoes complete fatty replacement if the tendon is excised. Transfer of the FDL and medial displacement calcaneal osteotomy produce a satisfactory improvement in hindfoot function; the outcome was the same whether the PT tendon was sacrificed or left intact.

摘要

背景

这项前瞻性研究的目的是评估趾长屈肌（FDL）和胫后肌（PT）对Ⅱ期胫后肌腱功能障碍（PTTD）行FDL肌腱转位及跟骨内侧移位截骨术的反应。

方法

12例患者根据PT肌腱是否切除分为两组（切除肌腱组和完整肌腱组）。利用术前和术后MRI的横截面积（CSA）分析测量并比较双腿FDL和PT肌肉的体积。

结果

术前，两组患者患侧PT肌肉体积平均较对侧正常侧减少11%，FDL肌肉体积平均增加17%。两组术后1年（平均13.4个月），与对侧正常侧相比，FDL肌肉体积平均增加27%，PT肌肉体积减少23%。切除肌腱组FDL体积增加44%，而完整肌腱组增加11%。切除肌腱组未评估PT肌肉体积，因为所有PT肌肉均已被脂肪浸润替代。完整肌腱组PT体积较对侧正常侧术前减少6%，术后进一步减少至23%。美国矫形足踝协会（AOFAS）后足评分从术前的50分提高到术后1年的88分。切除肌腱组（47至87分）和完整肌腱组（53至89分）的评分无差异。