Salamon Michael L, Pinney Stephen J, Van Bergeyk Anthony, Hazelwood Scott
Orthopaedic Surgery, Louisville, KY 40207, USA.
Foot Ankle Int. 2006 Jun;27(6):411-3. doi: 10.1177/107110070602700604.
Percutaneous Achilles tendon lengthening is frequently done to treat gastrocsoleus equinus contracture. To our knowledge, no study has documented the proximity of tendinous or neurovascular structures to the nearest edges of each hemisection in a percutaneous Achilles tendon lengthening, the complication rates related to injury of such structures, or the Achilles tendon rupture rates from inaccurate cuts. Thus, our goal was to document these distances and determine the accuracy of this procedure.
We performed triple-hemisection percutaneous Achilles tendon lengthening (Hoke technique) in 15 cadaver specimens and documented the distance from each cut edge to various relevant anatomical structures. We also documented the accuracy of each cut (diameter of hemisection divided by total tendon diameter), with a reference goal of 50% transection at each level.
We found that percutaneous Achilles tendon lengthening is a relatively accurate procedure with hemisections averaging 50% for the middle cut and 60% at the most proximal cut, and 55% at the distal cut. Some tendinous and neurovascular structures are, on average, less than 1 cm from the nearest margin of a given hemisection and are, therefore, at risk. These included the flexor hallucis longus at the middle and proximal cuts (9.1 mm and 5.7 mm, respectively), the tibial nerve at the proximal cut (8.3 mm), and the sural nerve at the middle-lateral cut (7.9 mm).
In cadavers, reasonably accurate cuts can be made, with some vital structures less than 1 cm from the cut tendon.
经皮跟腱延长术常用于治疗小腿三头肌马蹄足挛缩。据我们所知，尚无研究记录经皮跟腱延长术中腱性或神经血管结构与每个半切面最边缘的距离、与此类结构损伤相关的并发症发生率，或因切割不准确导致的跟腱断裂率。因此，我们的目标是记录这些距离并确定该手术的准确性。
我们对15具尸体标本进行了三半切面经皮跟腱延长术（霍克技术），并记录了每个切割边缘与各种相关解剖结构的距离。我们还记录了每次切割的准确性（半切面直径除以肌腱总直径），每个层面的参考目标是横断50%。
我们发现经皮跟腱延长术是一种相对准确的手术，中间切口的半切面平均为50%，最近端切口为60%，远端切口为55%。一些腱性和神经血管结构平均距离给定半切面的最近边缘不到1厘米，因此有风险。这些结构包括中间和近端切口处的拇长屈肌（分别为9.1毫米和5.7毫米）、近端切口处的胫神经（8.3毫米）以及中外侧切口处的腓肠神经（7.9毫米）。
在尸体中，可以进行相当准确的切割，一些重要结构距离切割的肌腱不到1厘米。
