University of Zurich, Zurich, Switzerland.
Foot Ankle Int. 2013 Aug;34(8):1100-10. doi: 10.1177/1071100713487725. Epub 2013 Apr 26.
Transfer of the flexor hallucis longus (FHL) tendon aims to restore function and relieve pain in chronic Achilles tendon (AT) disease. The goal of the present study was to investigate the clinical and radiographic outcomes of FHL transfer to the AT and to compare the transtendinous technique to the transosseous technique. We hypothesized that the type of technique would have a notable impact on outcome.
Forty patients (42 ankles) were retrospectively reviewed and divided into group 1 (transtendinous technique, 22 patients/24 ankles) and group 2 (transosseous technique, 18 patients/18 ankles). Outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, Foot Function Index (FFI), and Short Form-36 (SF-36) scores. Magnetic resonance imaging of the lower leg was performed preoperatively to assess muscle quality and fatty infiltration. Postoperatively, isokinetic plantar flexion strength was assessed using a Con-Trex dynamometer.
In group 1 (follow-up, 73 months; age, 52 years), the AOFAS score improved from 66 points to 89 points (P < .001) with average values for the VISA-A of 76 points, FFI-D pain 15%, and FFI-D function 22%. In group 2 (follow-up, 35 months; age, 56 years), the AOFAS score increased from 59 points to 85 points (P < .001) with mean values for the VISA-A 76 points, FFI-D pain 25%, and FFI-D function 24%. At follow-up, the average SF-36 score in group 1 was 66% and in group 2 was 77%. Isokinetic testing at 30 deg/s in group 1 revealed notable weakness in the operated ankle averaging 54.7 N·m (75% of normal), and in group 2 the average was 58.2 N·m (77% of normal). No statistically significant differences were found between the groups.
The hypothesis was disproved. Both techniques for FHL transfer to AT, intratendinous and transosseous, provided good to excellent clinical and functional outcome in the treatment of irreparable AT disease.
Level III, retrospective comparative series.
为了恢复慢性跟腱（Achilles tendon，AT）疾病患者的功能并缓解疼痛，通常会对屈肌键长肌（flexor hallucis longus，FHL）肌腱进行转位。本研究旨在探讨 FHL 肌腱转位至 AT 的临床和影像学结果，并比较经腱和经骨两种技术。我们假设技术类型会对结果产生显著影响。
回顾性分析 40 例（42 足）患者，分为 1 组（经腱技术，22 例/24 足）和 2 组（经骨技术，18 例/18 足）。评估的结果参数包括美国矫形足踝协会（American Orthopaedic Foot & Ankle Society，AOFAS）后足评分、维多利亚运动评估-Achilles 评分（Victorian Institute of Sports Assessment-Achilles，VISA-A）、足部功能指数（Foot Function Index，FFI）和健康调查简表 36 项（Short Form-36，SF-36）。术前对小腿进行磁共振成像（magnetic resonance imaging，MRI）以评估肌肉质量和脂肪浸润情况。术后使用 Con-Trex 测力计评估等速向心足底屈肌力量。
1 组（随访时间 73 个月，年龄 52 岁）的 AOFAS 评分从 66 分提高到 89 分（P <.001），VISA-A 平均为 76 分，FFI-D 疼痛为 15%，FFI-D 功能为 22%。2 组（随访时间 35 个月，年龄 56 岁）的 AOFAS 评分从 59 分提高到 85 分（P <.001），VISA-A 平均为 76 分，FFI-D 疼痛为 25%，FFI-D 功能为 24%。1 组的平均 SF-36 评分为 66%，2 组为 77%。1 组的等速向心 30°/s 测试显示，患足的平均肌力为 54.7 N·m（正常的 75%），2 组的平均肌力为 58.2 N·m（正常的 77%）。两组间无统计学差异。
我们的假设被否定。经腱和经骨 FHL 肌腱转位 AT 治疗不可修复性 AT 疾病均能获得良好到优秀的临床和功能结果。
III 级，回顾性比较系列。
