Shen Po-Chih, Chou Shih-Hsiang, Chen Jian-Chih, Chen Shu-Jung, Tien Yin-Chun
Orthopedic Surgeon, Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Orthopedic Surgeon, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Orthopedic Surgeon, Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Foot Ankle Surg. 2017 May-Jun;56(3):478-483. doi: 10.1053/j.jfas.2017.01.008. Epub 2017 Mar 3.
Favorable results have been reported for tibialis posterior tendon transfers, which can effectively restore the dorsiflexion of the ankle and normal heel-to-toe gait. However, the commonly used methods for anchoring the transplanted tendon have some drawbacks. Therefore, we developed a new tendon-anchoring method to improve fixation of the transferred tendon and reduce the related complications. The new method entails tying the anchoring suture to the navicular bone instead of the button on the plantar foot to avoid wound complications. It requires no additional skin incisions or special equipment. We retrospectively evaluated 24 feet of 19 pediatric patients (13 [68.4%] females and 6 [31.6%] males) who had undergone anterior transfer of the tibialis posterior tendon with our new method from 2000 to 2013. All patients were clinically followed up. At the final follow-up visit, they were evaluated while standing and walking, and the range of motion of the foot was evaluated. The mean age at surgery was 7.8 (range 2 to 16) years. At the longest follow-up point, all the patients exhibited improved gait, except for 1 patient who required a secondary procedure. All the transferred tibialis posterior tendons could be palpated with certainty during active dorsiflexion or withdrawal of the foot. No tendon displacements, wound infections, or postoperative complications were observed. Fixation of a transferred tibialis posterior tendon by tying the suture to the navicular bone is simple and reliable. This technique can efficiently prevent the plantar ulcers that can develop with the traditional pull-out button method and provides a solution when appropriate-size bioabsorbable interference screws are unavailable.
已有报道称胫后肌腱转移术取得了良好效果，该手术能有效恢复踝关节背屈及正常的足跟到足尖步态。然而，常用的移植肌腱固定方法存在一些缺点。因此，我们开发了一种新的肌腱固定方法，以改善转移肌腱的固定并减少相关并发症。新方法是将固定缝线系在舟骨上，而非足底的纽扣上，以避免伤口并发症。它无需额外的皮肤切口或特殊设备。我们回顾性评估了19例儿科患者的24只脚（13例[68.4%]女性，6例[31.6%]男性），这些患者在2000年至2013年间采用我们的新方法接受了胫后肌腱前向转移术。所有患者均接受了临床随访。在最后一次随访时，对他们进行了站立和行走评估，并评估了足部的活动范围。手术时的平均年龄为7.8岁（范围2至16岁）。在最长随访点，除1例需要二次手术的患者外，所有患者的步态均有改善。在足部主动背屈或回撤时，均可明确触诊到所有转移的胫后肌腱。未观察到肌腱移位、伤口感染或术后并发症。通过将缝线系在舟骨上固定转移的胫后肌腱简单且可靠。该技术能有效预防传统拉出纽扣法可能出现的足底溃疡，并且在没有合适尺寸的生物可吸收加压螺钉时提供了一种解决方案。
