Victorian Orthopaedic Foot & Ankle Clinic, Richmond, Melbourne, Victoria, Australia.
Foot Ankle Int. 2010 Mar;31(3):212-9. doi: 10.3113/FAI.2010.0212.
The results of operative management for distal tibialis anterior tendinopathy (DTAT) without rupture have not previously been described in the literature. We present the results of 12 operative procedures.
Of 40 patients diagnosed clinically and radiographically with DTAT, we reviewed 11 patients who underwent surgery for failure of nonoperative management. Assessment included pre and postoperative AOFAS midfoot scores, clinical examination and postoperative VAS pain scoring, at a mean followup of 29 months.
Ten women (ten feet) and one man (2 feet) underwent surgery. The mean age at surgery was 59 years. The mean duration of symptoms prior to surgery was 1 year. The mean preoperative AOFAS score was 52. Preoperative MRI showed tendinosis in two tendons and tendinosis with longitudinal split tears in ten tendons. Six of the twelve cases showed some associated degenerative changes of the midfoot. Six tendons were simply debrided and the insertion reinforced with a suture anchor. Six tendons were augmented with an extensor hallucis longus (EHL) transfer into the medial cuneiform. All patients improved postoperatively, with a mean improvement in AOFAS score of 33 and the mean postoperative pain VAS of 0.9 out of 10. Two patients underwent concomitant procedures on the same foot. Three of the six treated with EHL transfer have some symptomatic hallux interphalangeal joint extensor lag. In six cases the patient was completely satisfied. Three were satisfied with minor reservations. Of the three that were dissatisfied, two underwent subsequent surgery improving their symptoms. The third, though pain-free, was troubled by her toe-catching when walking barefoot. No patient regretted having had the surgery.
Debridement and repair of DTAT, with EHL augmentation for greater than 50% tendon involvement, provided a high level of patient satisfaction after nonoperative management failed in this series.
此前文献中并未描述过未发生断裂的胫骨前肌腱止点处（DTAT）病变的手术治疗结果。我们报告了 12 例手术治疗结果。
在 40 例临床和影像学诊断为 DTAT 的患者中，我们回顾了 11 例经手术治疗但非手术治疗失败的患者。评估包括术前和术后 AOFAS 中足评分、临床检查和术后 VAS 疼痛评分，平均随访 29 个月。
10 例女性（10 足）和 1 例男性（2 足）接受了手术。手术时的平均年龄为 59 岁。术前症状的平均持续时间为 1 年。术前 AOFAS 评分为 52 分。术前 MRI 显示 2 根肌腱存在腱病，10 根肌腱存在腱病伴纵向撕裂。12 例中有 6 例存在中足的一些相关退行性改变。12 例中有 6 例肌腱单纯清创，用缝线锚钉加强肌腱止点。12 例中有 6 例肌腱用伸肌肌腱（EHL）转位到内侧楔骨进行增强。所有患者术后均有改善，AOFAS 评分平均提高 33 分，术后疼痛 VAS 平均为 10 分中的 0.9 分。2 例患者在同一足部同时进行了其他手术。EHL 转位治疗的 6 例中有 3 例存在大脚趾间关节伸肌的症状性迟滞。6 例中有 6 例患者完全满意。3 例有轻微保留意见，但满意。3 例不满意的患者中有 2 例随后接受了手术，改善了症状。第 3 例虽然无疼痛，但赤脚行走时脚趾被绊住。没有患者后悔接受了手术。
在非手术治疗失败后，对于大于 50%肌腱受累的 DTAT 病变，行清创和修复，并辅以 EHL 增强，可获得较高的患者满意度。
