Villanueva Manuel, Iborra Álvaro, Ruiz María Del Mar, Sanz-Ruiz Pablo
Orthopaedic Surgeon, Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain.
Podiatrist, Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain.
J Foot Ankle Surg. 2019 Sep;58(5):870-876. doi: 10.1053/j.jfas.2018.12.027. Epub 2019 Jul 23.
Selective proximal recession of the medial gastrocnemius head has clear advantages over other approaches and can be performed as a single or combined open procedure for many indications. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultraminimally invasive proximal gastrocnemius recession. We performed a pilot study with 16 cadavers to ensure that the technique was effective and safe; we then prospectively performed gastrocnemius recession in 12 patients (23 cases) with gastrocnemius contracture associated with other indications. We evaluated pre- and postprocedure dorsiflexion, clinical outcomes (based on the visual analog scale and American Orthopedic Foot and Ankle Society scores), and potential complications. We achieved effective release of the proximal medial gastrocnemius tendon in all cases, with no damage to other tissue. Ankle dorsiflexion increased 12° (range 6° to 18°) (p = .05) and was maintained throughout follow-up. The mean preoperative visual analog scale score was 7 (range 5 to 9), which improved to 1 (range 0 to 2) (p = .01). The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score improved from a mean of 25 (range 20 to 40) to 85 (range 80 to 100) at 6 months and 90 at 12 months (p = .01). No major complications were observed. We considered the technique to be safe and effective for ultrasound-guided ultraminimally invasive proximal-medial gastrocnemius recession using a 1-mm incision in vivo. This novel technique is an alternative to open techniques, with encouraging results and with the potential advantages of reducing pain and obviating lower limb ischemia and deep anesthesia, thus decreasing complications and contraindications and accelerating recovery, although further studies are required.
与其他方法相比，选择性腓肠肌内侧头肌近端松解术具有明显优势，可作为单一或联合开放手术用于多种适应症。本研究的目的是评估基于超声引导的超微创近端腓肠肌松解术的新技术的安全性和有效性。我们对16具尸体进行了一项初步研究，以确保该技术有效且安全；然后，我们对12例（23例）伴有其他适应症的腓肠肌挛缩患者进行了前瞻性腓肠肌松解术。我们评估了术前和术后的背屈情况、临床结果（基于视觉模拟评分和美国矫形足踝协会评分）以及潜在并发症。所有病例均实现了腓肠肌内侧头肌腱的有效松解，且未对其他组织造成损伤。踝关节背屈增加了12°（范围为6°至18°）（p = 0.05），且在整个随访过程中保持不变。术前视觉模拟评分的平均值为7（范围为5至9），术后改善至1（范围为0至2）（p = 0.01）。美国矫形足踝协会踝-后足评分在6个月时从平均25（范围为20至40）提高到85（范围为80至100），在12个月时提高到90（p = 0.01）。未观察到重大并发症。我们认为该技术对于在体内使用1毫米切口进行超声引导的超微创近端内侧腓肠肌松解术是安全有效的。这种新技术是开放技术的一种替代方法，结果令人鼓舞，具有减轻疼痛、避免下肢缺血和深度麻醉的潜在优势，从而减少并发症和禁忌症并加速恢复，尽管还需要进一步研究。
