Besse J L, Lerat J L, Moyen B, Vincent P, Brunet-Guedj E
Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital Edouard Herriot, Lyon.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(5):453-7.
The authors describe a new surgical technique of tendo achilles reconstruction using bone tendon plasty from the patellar tendon, for rare chronic ruptures of the Achilles tendon flush within its calcaneal insertion, with distal loss of substance, requiring bone fixation.
The two step operation was carried out either in lateral or ventral decubitus (the latter two involving repositioning the patient): 1) Plasty harvesting. By a short anterior approach, we harvested either a strip of patellar tendon (10 mm wide) with a piece of tibia tuberosity or a strip of rectus femoris tendon (10 mm wide, up to 10-15 cm long) with a piece of patellar bone, in cases with a greater loss of substance. Tendo achilles reconstruction: following resection of fibrous tissue, and drilling of a blind calcaneous tunnel, the bone plasty is fitted into the calcaneous with interference screw for safety, the two tendon ends are superposed and sutured. The patient is placed in a cast for two months.
Two patients (1 thirty-eight year old sportsman, 1 thirty-seven year old woman) were treated with a good morphological and functional outcome at two years.
This new technique is compared with other available solutions: triceps plasty, other local tendon plasties, artificial plasties, It met the two criteria for these unusual ruptures: solid calcaneous fixation, no skin damage.
作者描述了一种新的手术技术，即使用髌腱进行骨腱成形术重建跟腱，用于跟腱在跟骨附着处罕见的慢性断裂，伴有远端组织缺失且需要骨固定的情况。
分两步进行手术，患者取侧卧位或腹卧位（后两种情况需重新摆放患者体位）：1）成形术取材。通过短前路，我们取材一条带胫骨结节的髌腱条（宽10毫米），或在组织缺失较多的情况下取材一条带髌骨块的股直肌腱条（宽10毫米，长达10 - 15厘米）。跟腱重建：切除纤维组织并钻一个跟骨盲孔隧道后，将骨成形物用干涉螺钉安全地植入跟骨，将两条肌腱断端重叠并缝合。患者需打两个月石膏。
两名患者（一名38岁运动员，一名37岁女性）接受治疗，两年后形态和功能恢复良好。
将这项新技术与其他可用方法进行了比较：肱三头肌成形术、其他局部肌腱成形术、人工成形术。它满足了这些特殊断裂的两个标准：跟骨牢固固定，无皮肤损伤。
