New England Baptist Hospital, Division of Foot and Ankle Orthopaedics, Boston Sports and Shoulder Center, Chestnut Hill, MA 02467, USA.
Foot Ankle Int. 2013 May;34(5):666-72. doi: 10.1177/1071100712470939. Epub 2013 Jan 14.
Although peroneal tendon injuries are a common cause of lateral ankle pain, there is a paucity of literature specifically addressing the treatment of severe concomitant peroneus longus and brevis tears. The purpose of this study was to evaluate patient outcomes following a single-stage flexor tendon transfer for the treatment of severe concomitant tears of both peroneal tendons.
Eight patients were treated with a single-stage flexor tendon transfer for severe concomitant peroneus longus and brevis tears over a 15-year period. Mean age at the time of surgery was 54 years (range, 41-67 years), including 4 male and 4 female patients. Tendon transfer of either the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) was performed when both peroneal tendons were found intraoperatively to have severe nonreconstructable tears. Mean follow-up time from surgery was 58 months (range, 12-91 months). Preoperative and postoperative AOFAS hindfoot and visual analog pain scores were prospectively collected, and patient charts were reviewed for complications. A postoperative outcome questionnaire was administered during latest follow-up to assess return to activities, satisfaction, and self-rated patient outcome.
Mean pre- and postoperative AOFAS hindfoot scores increased from 64 (range, 54-77) to 86 (range, 69-100), whereas mean score for pain on a visual analog scale decreased from 4.2 (range, 0.5-6) to 0.7 (range, 0-3). One surgical complication occurred following FDL transfer in a patient who developed a transient peroneal nerve palsy, and 1 patient underwent a subsequent calcaneal osteotomy. Seven of 8 patients reported a return to preoperative activity levels, and no patient required bracing for activities of daily living. All patients reported satisfaction with surgical results, and 7 rated their outcomes as good or excellent.
Single-stage flexor tendon transfer is an effective surgical option for the treatment of severe concomitant peroneus longus and brevis tendon tears.
Level IV, case series.
尽管腓肠肌腱损伤是导致外踝疼痛的常见原因，但针对严重的腓骨长肌和腓骨短肌同时撕裂的治疗方法文献却很少。本研究旨在评估一期肌腱转移术治疗严重的腓骨长肌和腓骨短肌同时撕裂的患者的治疗效果。
在过去的 15 年中，我们对 8 例严重的腓骨长肌和腓骨短肌同时撕裂患者进行了一期肌腱转移术治疗。手术时的平均年龄为 54 岁（范围，41-67 岁），包括 4 名男性和 4 名女性患者。当术中发现两条腓肠肌腱均有严重的不可重建撕裂时，行游离趾长屈肌腱（FHL）或游离𧿹长屈肌腱（FDL）肌腱转移术。从手术到最后一次随访的平均随访时间为 58 个月（范围，12-91 个月）。前瞻性收集术前和术后美国足踝外科协会（AOFAS）后足和视觉模拟疼痛评分，并对患者病历进行回顾以评估并发症。在最新随访时进行术后结果问卷调查，以评估活动的恢复情况、满意度和自我评估的患者结局。
平均术前和术后 AOFAS 后足评分从 64 分（范围，54-77 分）增加到 86 分（范围，69-100 分），而视觉模拟评分的疼痛评分从 4.2 分（范围，0.5-6 分）降至 0.7 分（范围，0-3 分）。1 例 FDL 转移术后患者出现短暂的腓总神经麻痹，发生 1 例手术并发症。1 例患者接受了后续的跟骨截骨术。8 例患者中有 7 例恢复了术前的活动水平，无患者日常生活需要支具。所有患者均对手术结果满意，7 例患者将其结果评为良好或优秀。
一期肌腱转移术是治疗严重的腓骨长肌和腓骨短肌同时撕裂的有效手术方法。
IV 级，病例系列。
