Dr Md Alauddin, Assistant Professor, Department of Orthopaedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2022 Jul;31(3):861-868.
The tendo achilles is one of most important tendon in human body which often injured through direct trauma or indirect stress on a weakened tendon. Longer the duration after injury the injured parts likely to move apart, fibrosis and degeneration leading to difficulty in repair or reconstruction. Usually a phase of 4 weeks or more without specific treatment is regarded as chronic or neglected rupture. Different authors described many management protocols about the tendo achilles rupture but there is no procedure of choice for neglected rupture with long gap. Prospective case series of 21 patients of neglected tendo achilles rupture with long gap treated with flexor hallucis longus tendon (FHLT) transfer was taken for study from January 2019 to December 2020 in Mymensingh Medical College Hospital, Bangladesh. Average age of patients was 39.47 years with range 22-65 years. Fifteen (15) cases of traumatic rupture in this study with average age 32.66 years and pathologic 6 cases with average age 56.5 years were recorded. We grafted FHLT from channel by incising Henry's knot. Krackow et al.'s technique was followed for tendon mobilization and bone fixation. We made procedure simpler and cheaper; instead of using interference screw the sutured tendon pulled through the heel and anchored over rubber tube or button by Cole method. Post-operative complications were less with one patient with superficial infection which eventually recovered 3 cases of mild pain and 2 cases of numbness. Questionnaire for surgical outcome measure are satisfactory in 19 patients (90.47%). Final follow up AOFAS score at 6 month (91.61±5.41) was highly significant (p<0.001) in comparison to preoperative score (38.71±9.78). These are comparable to other study. Above mentioned scores indicate the reliability of the surgical system. But our study is a prospective case series with minimum cases. To establish the best procedure for neglected tendo achilles rupture with long gap we recommend further study with larger group and Randomized Controlled Trial (RCT) study among different procedure.
跟腱是人体最重要的肌腱之一，常因直接创伤或对薄弱肌腱的间接应力而受伤。受伤后持续时间越长，受伤部位越有可能分开，纤维化和变性导致修复或重建困难。通常，如果没有特定治疗，4 周或更长时间没有愈合就被认为是慢性或被忽视的断裂。不同的作者描述了许多关于跟腱断裂的治疗方案，但对于有较长间隙的被忽视的断裂，尚无首选的治疗方法。本研究纳入了 2019 年 1 月至 2020 年 12 月在孟加拉国 Mymensingh 医学院附属医院接受 FHLT 转移治疗的 21 例被忽视的长间隙跟腱断裂患者的前瞻性病例系列研究。患者平均年龄为 39.47 岁，范围为 22-65 岁。在这项研究中，15 例为创伤性断裂，平均年龄为 32.66 岁，6 例为病理性断裂，平均年龄为 56.5 岁。我们通过切开 Henry 结在通道中移植 FHLT。我们采用 Krackow 等的技术进行肌腱活动和骨固定。我们使手术过程更加简单和经济；我们没有使用干扰螺钉，而是将缝合的肌腱穿过脚跟，并用 Cole 法将其固定在橡胶管或纽扣上。术后并发症较少，1 例患者出现浅表感染，最终恢复，3 例患者出现轻度疼痛，2 例患者出现麻木。19 例患者（90.47%）对手术结果测量问卷满意。6 个月时的最终随访 AOFAS 评分（91.61±5.41）与术前评分（38.71±9.78）相比具有高度显著性（p<0.001）。这些与其他研究相似。上述评分表明了手术系统的可靠性。但我们的研究是一项前瞻性病例系列研究，病例数量较少。为了确定治疗长间隙被忽视的跟腱断裂的最佳方法，我们建议进行进一步的研究，包括更大的病例数和不同方法的随机对照试验（RCT）研究。
