Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt.
J Orthop Surg Res. 2024 Mar 6;19(1):168. doi: 10.1186/s13018-024-04625-y.
Achilles' tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair.
Our study's goal was to assess the clinical results of repairing chronic Achilles' tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap.
Our prospective interventional single arm study included 18 patients with chronic Achilles' tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side.
The mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8-12) after the injury. The median (IQR) length of flab was 4.5 (4.3-5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6-18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month.
The modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.
跟腱慢性断裂是一种常见的疾病，通常会被误诊或治疗不当。因此，患者通常会在后期出现并发症，影响其步态。需要手术切除以桥接间隙或加强肌腱修复的强度。
我们的研究目的是评估采用近端肌腱（跟腱-比目鱼肌）中间段作为翻转瓣修复慢性跟腱损伤的临床效果。
我们的前瞻性介入性单臂研究纳入了 2020 年 5 月至 2023 年 4 月在埃及开罗的爱资哈尔大学附属医院就诊的 18 例慢性跟腱断裂患者。通过影像学和临床检查确认患者的诊断。他们都接受了相同的开放式重建手术，使用改良 GSF 进行治疗。平均随访时间为 12 个月。该研究的结果通过跟腱断裂评分（ATRS）、美国矫形足踝协会（AOFAS）评分以及患侧重复提踵能力进行评估。
平均手术时间为 72.77 分钟。损伤后重建的中位数（IQR）时间为 10（8-12）分钟。中位（IQR）皮瓣长度为 4.5（4.3-5）cm。术中无并发症发生。典型的随访时间为 12 个月（6-18 个月）。根据 ATRS，我们发现从术前的 82.8±3 分显著降低到术后 12 个月的 20.8±6.7 分（P 值=0.001）。关于 AOFAS 评分，它从术前的 49.5±10 分增加到术后 12 个月的 83.8±8.5 分（P=0.001）。关于术后并发症，没有再断裂发生。两名患者出现浅表伤口感染，经每日换药和抗生素治疗后好转。此外，两名患者术后四个月出现轻微踝关节僵硬，第六个月开始进行计划性康复后改善。
改良 GSTF 是一种简单、安全、耐受良好、有效的治疗方法，具有良好的功能效果和更高的患者满意度。
