Li Zuowei, Xu Xiangyang, Liu Jinhao, Zhu Yuan, Xu Jiping
Department of Orthpaedics, Ruijin Hospital, Medicine School of Shanghai Jiao Tong University, Shanghai, 200025, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):306-8.
To evaluate the effectiveness of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture.
From October 2004 to June 2007, 32 patients (35 feet) with chronic Achilles tendon rupture were treated, including 21 males (22 feet) and 11 females (13 feet) and aging 32-85 years. The disease course was 4-132 days. There were 29 patients with hooflike movements history and 3 patients without obvious inducement. The result of Thompson test was positive in 31 cases (33 feet). The score was 56.09 +/- 7.25 according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system (AOFAS). MRI indicated that the gap of the chronic Achilles tendon rupture was 0.5-5.0 cm. Medial foot incision associated with medial heel incision or only medial heel incision was made to harvest flexor hallucis longus tendon. The tendon should be 3 cm longer than the end of the Achilles tendon, then fix the tendon to the calcaneus.
Wound dehiscence occurred and wound healed after dressing change in 1 case; wound healed by first intention in other patients. Thirty-two patients were followed up for 12-32 months (mean 19.4 months). The AOFAS score was 94.22 +/- 4.63, showing statistically significant difference when compared with that before operation (P < 0.01). The results were excellent in 28 cases, good in 3 cases and fair in 1 case. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury and lateral plantar nerve injury occurred.
Flexor hallucis longus tendon transfer offers a desirable outcome in operative recovery, tendon fixation and complications.
评估带袢纽扣钢板和拇长屈肌腱作为增强材料修复慢性跟腱断裂的有效性。
2004年10月至2007年6月，治疗32例（35足）慢性跟腱断裂患者，其中男21例（22足），女11例（13足），年龄32 - 85岁。病程4 - 132天。有马蹄状畸形病史29例，无明显诱因3例。31例（33足）Thompson试验阳性。根据美国足踝外科协会（AOFAS）踝 - 后足评分系统评分，术前评分为56.09±7.25分。MRI显示慢性跟腱断裂间隙为0.5 - 5.0 cm。采用内侧足切口联合内侧足跟切口或仅内侧足跟切口切取拇长屈肌腱。肌腱长度应比跟腱末端长3 cm，然后将肌腱固定于跟骨。
1例出现伤口裂开，换药后愈合；其余患者伤口一期愈合。32例患者随访12 - 32个月（平均19.4个月）。AOFAS评分为94.22±4.63分，与术前比较差异有统计学意义（P < 0.01）。优者28例，良者3例，可者1例。未发生腓肠神经损伤、胫后神经损伤、足底疼痛性瘢痕、足底内侧神经损伤及足底外侧神经损伤。
拇长屈肌腱转位在手术恢复、肌腱固定及并发症方面效果良好。
