Phillips Sierra, Shah Ashish, Staggers Jackson Rucker, Pinto Martim, Godoy-Santos Alexandre Leme, Naranje Sameer, de Cesar Netto Cesar
1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
2 Department of Orthopaedic Surgery, University of Sao Paulo (USP), Sao Paulo, SP, Brazil.
Foot Ankle Int. 2018 Apr;39(4):500-505. doi: 10.1177/1071100717745559. Epub 2017 Dec 18.
The objective of the study was to evaluate the accuracy of percutaneous Achilles tendon lengthening (TAL) using a triple hemisection technique and the improvement in ankle dorsiflexion.
Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of the Achilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Following forced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper.
The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3% ± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendon excursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm for the distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion data analysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degrees postprocedure. The dorsiflexion angle significantly increased ( P < .0001) at an average of 19.5 ± 5.0 degrees following TAL.
Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accurate technique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures are possible complications.
Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
本研究的目的是评估使用三重半切技术进行经皮跟腱延长术（TAL）的准确性以及踝关节背屈的改善情况。
使用10个新鲜冷冻的膝上尸体标本。对跟腱进行经皮三重半切（近端、中间和远端）。术前和术后使用数字测角仪评估最大踝关节背屈。经过适当解剖后，记录切口的相对宽度。在强制踝关节背屈后，用精密数字卡尺测量所有3个切口处拉伸间隙的位移。
经皮切口的总体相对宽度为跟腱直径的51.3%±16.3%，近端切口为44.3%±13.6%，中间切口为50.3%±15.6%，远端切口为59.3%±18.4%。近端切口的肌腱移位平均为13.0±3.8毫米，中间切口为12.5±4.7毫米，远端切口为8.2±3.7毫米。1具尸体的跟腱完全断裂，被排除在移位数据分析之外。术前踝关节背屈的平均活动范围为8.1±3.9度，术后为27.6±5.3度。跟腱延长术后背屈角度平均增加19.5±5.0度，显著增大（P<.0001）。
我们的尸体研究表明，经皮三重半切跟腱是一种准确的技术，可成功延长肌腱并增加踝关节背屈。完全断裂是可能的并发症。
我们的尸体研究表明，在临床情况下，跟腱三重半切术可以可靠地进行，踝关节背屈有显著改善，主要是通过近端和中间切口处肌腱移位增加实现的，且完全断裂的风险较低。
