内侧与完整近端腓肠肌切开术后踝关节背屈的比较：尸体研究。
Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study.
机构信息
Service de Chirurgie Orthopédique, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France.
Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, United Kingdom; Orthopaedic and Traumatology Unit, Department of Public Health, "Federico II" Naples University, Naples, Italy.
出版信息
Foot (Edinb). 2021 Dec;49:101842. doi: 10.1016/j.foot.2021.101842. Epub 2021 Jun 12.
PURPOSE
Gastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk's technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession.
METHODS
A cadaveric study was performed on 15 lower limb adult specimens. Isolated medial gastrocnemius head recession was initially performed, followed by an additional recession of the lateral gastrocnemius head. Ankle dorsiflexion torque was applied with 2 and 4 kg forces on second metatarsal head. Ankle dorsiflexion was measured with the knee both in extension and at 90° of flexion and values were recorded before surgery (T0), after medial head recession (T1) and after both heads recession (T2). Normality of data was assessed using the Shapiro-Wilk test, then measurements were compared in the three conditions with appropriate statistical tests.
RESULTS
After isolated medial gastrocnemius recession (Δ = T1-T0), ankle dorsiflexion assessed with the knee in extension significantly increased by 5° ± 3 (range, -2 to 10) with a 2-kg torque (p = 0.02) and by 4.5° ± 3 (range, -4 to 10) with a 4-kg torque (p = 0.04). No significant difference was observed with the knee flexed at 90° (p > 0.05 for all measurements). After both gastrocnemius heads recession (Δ = T2-T1), although a further increase in dorsiflexion was noticed, statistical significance was not reached neither with the knee in extension nor at 90° of flexion (p > 0.05 for all measurements).
CONCLUSION
In this study, isolated medial gastrocnemius head recession performed according to LS Barouk's technique was effective in improving ankle dorsiflexion, whereas the additional release of the lateral head did not produce any significant change.
LEVEL OF EVIDENCE
Level V, cadaveric study.
目的
腓肠肌切除术已被用于治疗腓肠肌挛缩。本研究的目的是：（1）评估根据 L.S. Barouk 技术行单纯内侧腓肠肌切除术后踝关节背屈的变化；（2）比较单纯内侧头与完整近端腓肠肌切除术后踝关节背屈。
方法
对 15 例成人下肢标本进行尸体研究。首先行单纯内侧腓肠肌头切除术，然后再行外侧腓肠肌头切除术。在第二跖骨头处用 2kg 和 4kg 的力施加踝关节背屈扭矩。在膝关节伸直和 90°屈曲两种状态下测量踝关节背屈角度，记录术前（T0）、单纯内侧头切除后（T1）和双侧头切除后（T2）的测量值。使用 Shapiro-Wilk 检验评估数据的正态性，然后使用适当的统计检验比较三种情况下的测量值。
结果
行单纯内侧腓肠肌切除术后（Δ = T1-T0），在膝关节伸直位，用 2kg 扭矩时踝关节背屈增加 5°±3（范围：-2 至 10）（p = 0.02），用 4kg 扭矩时增加 4.5°±3（范围：-4 至 10）（p = 0.04）。在膝关节屈曲 90°时，差异无统计学意义（所有测量值 p > 0.05）。行双侧腓肠肌头切除术后（Δ = T2-T1），尽管背屈进一步增加，但在膝关节伸直和屈曲 90°时均未达到统计学意义（所有测量值 p > 0.05）。
结论
在这项研究中，根据 L.S. Barouk 技术行单纯内侧腓肠肌头切除可有效改善踝关节背屈，而外侧头的进一步松解并不能产生明显的变化。
证据等级
5 级，尸体研究。
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