Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Foot Ankle Int. 2013 Sep;34(9):1212-20. doi: 10.1177/1071100713487527. Epub 2013 Apr 23.
Irreparable peroneal tendon tears are uncommon and require complex surgical decision making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We describe our technique and present our results using this method.
A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneal tendons. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scale (VAS) score for pain, Short Form-12 (SF-12) physical health survey, Lower Extremity Functional Score (LEFS), and complications were reviewed.
Fourteen patients with peroneal tendon ruptures requiring reconstruction were identified. Mean follow-up was 17 months (range, 7-47 months; median, 12 months). The average length of the intercalary segment reconstructed was 10.8 ± 3.8 cm (range, 6-20 cm). The average postoperative VAS score decreased to 1.0 ± 1.4 (P = .0005). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength as categorized by the Medical Research Council grading scale improved to 4.8 ± 0.5 (P = .001). The average SF-12 score improved to 48.8 ± 7.8 (P = .02). The average LEFS improved to 86.4. ± 14.9 (P = .00001). Four patients experienced sensory numbness in the sural nerve distribution, and 2 of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures, or reoperations. No allograft associated complications were encountered. All patients returned to their preinjury activity levels.
Allograft reconstruction of the peroneal tendons can improve strength, decrease pain, and yield satisfactory patient-reported outcomes. It can be performed without incurring the deleterious effects associated with tendon transfer procedures. We believe that allograft reconstruction is a safe and useful alternative in the treatment of irreparable peroneal tendon ruptures.
Level IV, retrospective case series.
不可修复的腓骨肌腱撕裂较为少见，需要进行复杂的手术决策。中间节段同种异体移植物重建已被先前描述为一种治疗选择；然而，文献中尚无关于该技术结果的报道。我们描述了我们的技术，并展示了使用该方法的结果。
对所有接受腓骨肌腱中间节段同种异体重建的患者进行回顾性图表审查。分析损伤机制、同时进行的手术操作、相关的影像学发现、术前和术后体格检查、中间节段移植物的长度、病史、疼痛视觉模拟量表 (VAS) 评分、健康调查简表 12 项 (SF-12) 生理健康评分、下肢功能评分 (LEFS) 和并发症。
确定了 14 例需要重建的腓骨肌腱断裂患者。平均随访时间为 17 个月（范围 7-47 个月；中位数 12 个月）。重建的中间节段的平均长度为 10.8 ± 3.8cm（范围 6-20cm）。术后平均 VAS 评分降至 1.0 ± 1.4（P =.0005）。没有患者的术后疼痛评分高于术前疼痛评分。根据医学研究委员会分级标准，术后外翻力量平均改善至 4.8 ± 0.5（P =.001）。SF-12 评分平均提高至 48.8 ± 7.8（P =.02）。LEFS 平均提高至 86.4 ± 14.9（P =.00001）。4 例患者出现腓肠神经分布区感觉麻木，其中 2 例为一过性。无术后伤口愈合并发症、感染、肌腱再断裂或再次手术。无移植物相关并发症。所有患者均恢复到受伤前的活动水平。
腓骨肌腱同种异体重建可改善力量、减轻疼痛并获得令人满意的患者报告结果。它可以在不产生与肌腱转移手术相关的有害影响的情况下进行。我们认为同种异体重建是治疗不可修复的腓骨肌腱撕裂的一种安全且有用的替代方法。
IV 级，回顾性病例系列。
