Stockton Kristopher G, Brodsky James W
Baylor University Medical Center, Dallas, TX, USA.
Foot Ankle Int. 2014 Apr;35(4):346-52. doi: 10.1177/1071100714522026. Epub 2014 Feb 6.
There is a range of different types of tears and pathology of the peroneal tendons. One of the least common types is the tear of the peroneus longus associated with fracture, enlargement, or entrapment at the cuboid tunnel of the os peroneum. The purpose of this study was to evaluate the pathologic patterns of these uncommon peroneal tendon tears, to review the treatment, and to report the patient outcomes following treatment with excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis.
A 5-year retrospective review of all patients with peroneal tendon tears identified 12 patients operatively treated for peroneus longus tendon tears with associated pathology of the os peroneum, and in whom there was a viable peroneus brevis. All patients were treated with an operative procedure consisting of excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. Mean age was 51.5 (range, 33 to 73) years, including 7 males and 5 females. Operative and radiographic records were reviewed to characterize the nature of the peroneus longus tears and associated pathology. Preoperative and postoperative AOFAS hindfoot, SF-36 questionnaires, and Visual Analog Scale (VAS) pain scores were compiled and patient records were reviewed for complications. Mean follow-up after surgery was 63.3 (range, 12 to 114) months.
All of the patients had an os peroneum associated with a complex, irreparable tear of the peroneus longus tendon. The peroneus longus was typically enlarged, fibrotic, and adhered to the surrounding tissues. In 8 patients, the peroneus longus tendon tear was associated with a fracture of the os peroneum, and in 4 patients with an enlarged and entrapped os peroneum which prevented movement at the cuboid tunnel. Of the 12 patients, 9 had partial tears of the peroneus brevis, which were treated with debridement and suture repair. AOFAS hindfoot scores increased from a preoperative mean of 61 (range, 46 to 75) to a postoperative mean of 91.7 (range, 60 to 100). Mean preoperative SF-36 Physical Component Scores (PCS) increased from 36 to 52 postoperatively. Mean VAS pain scores decreased from a preoperative mean of 6.3 (range, 4 to 8) to a postoperative mean of 1.0 (range, 0 to 4). Complications included 2 patients with sural neuritis and 3 with superficial delayed wound healing successfully treated nonoperatively.
Tears of the distal peroneus longus tendon, which are much less commonly reported than tears of the peroneus brevis, can be associated with pathology of the os peroneum. Excision of the os peroneum, tendon debridement, and tenodesis of the longus to brevis was an effective surgical technique.
Level IV, case series.
腓骨肌腱存在多种不同类型的撕裂和病变。其中最不常见的类型之一是与腓籽骨骨折、增大或在腓籽骨骰骨隧道处卡压相关的腓骨长肌撕裂。本研究的目的是评估这些不常见的腓骨肌腱撕裂的病理模式，回顾治疗方法，并报告腓籽骨切除、清创以及腓骨长肌与腓骨短肌肌腱固定术后的患者预后。
对所有腓骨肌腱撕裂患者进行了为期5年的回顾性研究，确定了12例因腓骨长肌肌腱撕裂合并腓籽骨病变且腓骨短肌存活而接受手术治疗的患者。所有患者均接受了包括腓籽骨切除、清创以及腓骨长肌与腓骨短肌肌腱固定的手术。平均年龄为51.5岁（范围33至73岁），其中男性7例，女性5例。回顾手术和影像学记录以明确腓骨长肌撕裂的性质及相关病变。收集术前和术后的美国足踝外科协会（AOFAS）后足评分、SF-36问卷以及视觉模拟量表（VAS）疼痛评分，并检查患者记录以了解并发症情况。术后平均随访63.3个月（范围12至114个月）。
所有患者的腓籽骨均与腓骨长肌肌腱复杂且无法修复的撕裂相关。腓骨长肌通常肿大、纤维化并与周围组织粘连。8例患者的腓骨长肌肌腱撕裂与腓籽骨骨折相关，4例患者的腓籽骨增大并卡压，导致骰骨隧道处活动受限。12例患者中，9例腓骨短肌有部分撕裂，采用清创和缝合修复治疗。AOFAS后足评分从术前平均61分（范围46至75分）提高到术后平均91.7分（范围60至100分）。术前SF-36身体成分评分（PCS）平均为36分，术后提高到52分。VAS疼痛评分从术前平均6.3分（范围4至8分）降至术后平均1.0分（范围0至4分）。并发症包括2例腓肠神经炎患者和3例浅表伤口愈合延迟患者，均通过非手术治疗成功治愈。
腓骨长肌远端肌腱撕裂的报道远比腓骨短肌肌腱撕裂少见，且可能与腓籽骨病变有关。腓籽骨切除、肌腱清创以及长肌与短肌肌腱固定是一种有效的手术技术。
IV级，病例系列。
