Faculty of Health Sciences At Manresa, Department of Podiatry, Universidad de Vic-Universidad Central de Catalunya (UVic-Ucc), Clinic Vitruvio Biomecánica, BarcelonaMadrid, Spain.
Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain.
Surg Radiol Anat. 2021 Jan;43(1):53-61. doi: 10.1007/s00276-020-02536-1. Epub 2020 Jul 23.
The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the "GIAR"- technique: the gastrocnemius-intramuscular aponeurosis release.
An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6 years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2 mm (± 1 mm). The mean gain at the ankle joint ROM after the GIAR was 7.9° (± 1.1°). No damages of important anatomical structures could be found.
Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.
延长腓肠肌腱膜的手术本身是为了治疗与跟腱-腓肠肌复合体挛缩相关的多种肌肉骨骼、神经和代谢性疾病，如足底筋膜炎、跟腱病、跖骨痛、脑瘫或糖尿病足溃疡。因此，我们的研究目的是证明一种新的超声引导手术技术——“GIAR”技术，即腓肠肌-肌内肌腱膜松解术，用于延长前腓肠肌腱膜的有效性和安全性。
对 10 个新鲜冷冻标本（10 个供体，8 个男性，2 个女性，5 个左侧，5 个右侧）进行了超声引导下的 GIAR 手术。捐赠体被排除的标准为 BMI 超过 35（超声回声性受损）、踝和小腿区域有创伤迹象、有踝或足部缺血性血管疾病、手术或占位性病变史。手术由两位具有 6 年以上超声引导手术经验的足病医生进行。10 个标本中有 10 个完全切断了前腓肠肌腱膜，平均门长为 2mm（±1mm）。GIAR 后踝关节 ROM 的平均增加量为 7.9°（±1.1°）。未发现重要解剖结构受损。
本研究结果表明，我们新的超声引导下前腓肠肌腱膜延长术（GIAR）可能是一种有效且安全的手术。
