Qi Jin, Xia Yayi, Wang Yuliang, Zhao Lin, Yao Changjiang
Department of Orthopaedics, Second Affiliated Hospital of Lanzhou University, Lanzhou Gansu 730030, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1202-5.
To evaluate the effectiveness of hamstring tendon and flexor hallucis longus (FHL) tendon autograft for Achilles tendon defects reconstruction.
Between February 2009 and October 2011, 9 patients (9 feet) with Achilles tendon defect were treated with hamstring tendon and FHL tendon autograft. Of 9 cases, 6 were male and 3 were female with an average age of 43 years (range, 21-65 years), including 5 cases of chronic Achilles tendon ruptures caused by sport injury and 4 cases of Achilles tendon defects caused by resection of tendon lesion (2 cases of hyaline degeneration with necrosis, 1 case of giant cell tumor, and 1 case of chronic inflammation with hyaline degeneration). The disease duration ranged from 31 to 387 days (mean, 137.6 days). The defect length was 5 to 18 cm (mean, 8.6 cm). Functional exercise of the ankle began at 6 weeks after plaster fixation.
Dehiscence and effusion occurred in 2 cases and plantar pain caused by injury of tibial nerve in 1 case; primary healing of wound was obtained in the other patients without complication. Nine patients were followed up 19.7 months on average (range, 13-25 months); no re-rupture was observed. There was no significant difference in the dorsal extension between at preoperation and at 1 year and last follow-up after operation (P > 0.05); the ankle plantar flexion at 1 year and last follow-up after operation was significantly larger than that at preoperation (P < 0.05). The ankle plantar flexion and dorsal extension at 1 year and last follow-up after operation were significantly larger than those at 3 months after operation (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P > 0.05). American Orthopaedic Foot and Ankle Society (AOFAS) and short-form 36 health survey scale (SF-36) scores were significantly increased at postoperation when compared with scores at preoperation (P < 0.05), and the scores at last follow-up were significantly higher than those at 3 months after operation (P < 0.05). The Achilles tendon total rupture score (ATRS) at last follow-up was significantly higher than that at 3 months after operation (t = -7.982, P = 0.000).
Combined hamstring tendon and FHL tendon autograft is one of the effect methods to reconstruction Achilles tendon defects.
评估腘绳肌腱与拇长屈肌腱（FHL）自体移植修复跟腱缺损的有效性。
2009年2月至2011年10月，对9例（9足）跟腱缺损患者采用腘绳肌腱与FHL肌腱自体移植治疗。9例中，男6例，女3例，平均年龄43岁（范围21 - 65岁），其中运动损伤致慢性跟腱断裂5例，肌腱病变切除后导致跟腱缺损4例（透明变性坏死2例，巨细胞瘤1例，慢性炎症伴透明变性1例）。病程31至387天（平均137.6天）。缺损长度5至18厘米（平均8.6厘米）。石膏固定6周后开始踝关节功能锻炼。
2例出现切口裂开及积液，1例因胫神经损伤导致足底疼痛；其余患者伤口一期愈合，无并发症。9例患者平均随访19.7个月（范围13 - 25个月）；未观察到再次断裂。术前与术后1年及末次随访时背伸活动度比较差异无统计学意义（P > 0.05）；术后1年及末次随访时踝关节跖屈活动度显著大于术前（P < 0.05）。术后1年及末次随访时踝关节跖屈和背伸活动度显著大于术后3个月（P < 0.05），但1年与末次随访时比较差异无统计学意义（P > 0.05）。与术前比较，术后美国矫形足踝协会（AOFAS）评分及简短健康调查量表（SF - 36）评分显著升高（P < 0.05），末次随访时评分显著高于术后3个月（P < 0.05）。末次随访时跟腱完全断裂评分（ATRS）显著高于术后3个月（t = -7.982，P = 0.000）。
腘绳肌腱与FHL肌腱联合自体移植是修复跟腱缺损的有效方法之一。
