Miao Xudong, Wu Yongping, Tao Huimin, Yang Disheng, Huang Lu
Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China.
Indian J Orthop. 2016 Sep;50(5):523-528. doi: 10.4103/0019-5413.189599.
Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique.
35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18-72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings.
Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were statistically significant differences. The result of the total excellent and good rate was 93.8% (30/32). MRI of Achilles tendon showed even signal without evidence of tear or cystic degeneration.
Reconstruction of a chronic Achilles tendon rupture with an FHL tendon harvested using a minimally invasive technique showed good outcomes.
踇长屈肌腱（FHL）转移不仅可以重建跟腱，还能为缺血的肌腱组织提供丰富的血供以促进伤口愈合。本回顾性研究旨在探讨采用微创技术获取踇长屈肌腱修复Kuwada IV级慢性跟腱断裂患者的临床疗效。
本回顾性研究纳入了2006年7月至2011年6月间接受治疗的35例Kuwada IV级跟腱损伤患者。年龄在23至71岁之间。从初次受伤至手术的时间为29天至34个月（平均137.6天）。所有35例患者均存在小腿抬起困难。32例患者获得平均32.2个月（范围18 - 72个月）的随访，3例失访。磁共振成像（MRI）显示肌腱断裂间隙为6.0至9.2厘米。手术中，在足中部内侧足底侧垂直做一个2.0厘米的小切口，在踇趾趾间关节足底侧做一个1.5厘米的小横向切口以获取FHL肌腱，并用缝合锚将肌腱固定于跟骨。术后由物理治疗师根据美国矫形足踝协会 - 踝与后足评分（AOFAS - AH）以及Leppilahti跟腱评分对外观和功能进行评估。
对32例患者的结果进行了评估。除1例患者术后10天因伤口裂开出现并发症外，所有其他患者伤口均一期愈合，32例中有28例在末次随访时能够踮起脚尖。AOFAS - AH评分从术前的（51.92±7.08）分提高到（92.56±6.71）分；Leppilahti跟腱评分从术前的（72.56±7.43）提高到（92.58±5.1）。差异具有统计学意义。总优良率为93.8%（30/32）。跟腱MRI显示信号均匀，无撕裂或囊性变迹象。
采用微创技术获取FHL肌腱重建慢性跟腱断裂显示出良好的疗效。
