Roukis Thomas S, Schweinberger Monica H
Limb Preservation Service, Vascular/Endovascular Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
J Foot Ankle Surg. 2010 Jan-Feb;49(1):68-70. doi: 10.1053/j.jfas.2009.07.018.
The purpose of this article was to report the complications associated with uni-portal endoscopic gastrocnemius recession for surgical treatment of pathologic soft tissue ankle equinus contracture in diabetic patients. This is an observational case series involving a retrospective review of prospectively collected data of 23 uni-portal endoscopic gastrocnemius recessions used to treat pathologic soft tissue ankle equinus contracture in 18 consecutive diabetic patients between November 2006 and January 2009. Each patient underwent uni-portal endoscopic gastrocnemius recession under general or spinal anesthesia with thigh tourniquet control in combination with soft tissue and/or osseous reconstructive foot and/or ankle surgery. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 9 male and 9 female patients with a mean age +/- SD of 69.0 +/- 7.4-years (range: 47.0 to 71.0 years). There were 11 right and 12 left lower limbs involved, with 5 procedures performed bilateral. Complications included 3 conversions to an open incision secondary to difficulty dissecting through excessive adipose tissue, delayed healing of 3 incision sites in patients with uncontrolled diabetes mellitus at the time of surgery, and 3 undercorrections in patients with spastic contractures. The remainder of the procedures were deemed successful with no saphenous nerve, sural nerve, or lesser saphenous vein related injuries occurring. When properly performed, uni-portal endoscopic gastrocnemius recession represents a safe, reliable, and minimally invasive technique useful for correcting pathologic soft tissue ankle equinus contracture in patients with diabetes. A percutaneous tendo-Achilles lengthening should be performed in patients who have marginal arterial inflow that precludes tourniquet use or have a spastic contracture. An open rather than endoscopic gastrocnemius recession should be performed in patients with excessive adipose tissue. Before surgery, the risk of delayed wound healing should be discussed with patients who have uncontrolled diabetes mellitus and in-patient management with tight glycemic control considered.
本文旨在报告单孔内镜下腓肠肌松解术治疗糖尿病患者病理性软组织踝关节马蹄足挛缩的相关并发症。这是一项观察性病例系列研究，回顾性分析了2006年11月至2009年1月期间连续18例糖尿病患者接受23次单孔内镜下腓肠肌松解术治疗病理性软组织踝关节马蹄足挛缩的前瞻性收集数据。每位患者在全身麻醉或脊髓麻醉下，使用大腿止血带控制，同时进行软组织和/或骨性重建足和/或踝关节手术，接受单孔内镜下腓肠肌松解术。根据索引手术，患者保持非负重状态，随访至临床愈合或宣布失败。有9例男性和9例女性患者，平均年龄±标准差为69.0±7.4岁（范围：47.0至71.0岁）。涉及11例右下肢和12例左下肢，5例为双侧手术。并发症包括3例因过度脂肪组织解剖困难而转为开放切口，3例手术时糖尿病未得到控制的患者切口延迟愈合，以及3例痉挛性挛缩患者矫正不足。其余手术被认为成功，未发生与隐神经、腓肠神经或小隐静脉相关的损伤。当操作适当时，单孔内镜下腓肠肌松解术是一种安全、可靠且微创的技术，可用于纠正糖尿病患者的病理性软组织踝关节马蹄足挛缩。对于动脉血流边缘性不足而无法使用止血带或有痉挛性挛缩的患者，应进行经皮跟腱延长术。对于脂肪组织过多的患者，应进行开放而非内镜下腓肠肌松解术。手术前，应与糖尿病未得到控制的患者讨论伤口延迟愈合的风险，并考虑住院进行严格的血糖控制管理。
