Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.
Am J Sports Med. 2010 Nov;38(11):2304-12. doi: 10.1177/0363546510376619. Epub 2010 Aug 27.
A less-invasive technique to reconstruct chronic Achilles tendon rupture with transfer of the tendon of peroneus brevis is suitable in patients with a tendon gap less than 6 cm.
To report the results of a longitudinal study on reconstruction of chronic Achilles tendon rupture using a less-invasive peroneus brevis repair through 2 paramidline incisions.
Case series; Level of evidence, 4.
Thirty-two patients underwent surgery for chronic Achilles tendon rupture with a tendon gap during surgery less than 6 cm, occurring between 60 days and 9 months preoperatively. All participants were prospectively followed for 5 to 8 years; final review was performed at 48.4 ± 13.5 months from the operation. Clinical and functional assessment (anthropometric measurements, isometric strength, postoperative Achilles tendon total rupture score) was performed.
All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. No patient developed a clinically evident deep vein thrombosis or sustained a rerupture. Five patients were managed nonoperatively after a superficial infection of one of the surgical wounds. At final review, the maximum calf circumference remained significantly decreased in the operated leg (39.2 ± 6.2 cm [side with rupture] vs 40.9 ± 7.0 cm [uninjured side]; P = .04). The operated limb was significantly less strong than the nonoperated one (231.2 ± 132.4 N vs 275.3 ± 150.2 N; P = .033). The Achilles tendon total rupture score at final follow-up was 92.5 ± 14.2.
The management of chronic Achilles tendon tears by a less-invasive peroneus brevis repair is technically demanding but safe. It allows good recovery, even in patients with a chronic rupture of 9 months' duration. These patients should be warned that they are at risk for postoperative complications and that their ankle plantar flexion strength is likely to be reduced.
对于跟腱缺损小于 6cm 的慢性跟腱断裂患者，采用微创的腓骨短肌腱转移术进行重建是一种合适的方法。
报告通过 2 条中线切口进行微创腓骨短肌腱修复术治疗慢性跟腱断裂的纵向研究结果。
病例系列；证据等级，4 级。
32 例患者因慢性跟腱断裂接受手术治疗，术中跟腱缺损小于 6cm，术前病程 60 天至 9 个月。所有患者均前瞻性随访 5 至 8 年；末次随访时间为术后 48.4±13.5 个月。进行临床和功能评估（人体测量学测量、等长肌力、术后跟腱总断裂评分）。
所有患者均能踮脚行走，无患者使用足跟垫或跛行。无患者发生临床明显深静脉血栓形成或再断裂。5 例患者因其中 1 个手术切口浅表感染而接受非手术治疗。末次随访时，患侧小腿周径仍明显减小（39.2±6.2cm[断裂侧]与 40.9±7.0cm[未受伤侧]；P=.04）。患侧肢体明显弱于健侧（231.2±132.4N 与 275.3±150.2N；P=.033）。末次随访时，跟腱总断裂评分（Achilles tendon total rupture score，ATRS）为 92.5±14.2。
采用微创腓骨短肌腱转移术治疗慢性跟腱撕裂技术要求较高，但安全可靠。即使对于病程 9 个月的慢性跟腱断裂患者，也能获得良好的恢复。这些患者应被告知存在术后并发症的风险，且其踝关节跖屈肌力可能会下降。
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