Maffulli N, Testa V, Capasso G, Bifulco G, Binfield P M
Department of Orthopaedic Surgery, University of Aberdeen Medical School, Scotland.
Am J Sports Med. 1997 Nov-Dec;25(6):835-40. doi: 10.1177/036354659702500618.
From August 1989 to January 1995 we performed multiple percutaneous longitudinal tenotomies under local anesthetic on 52 middle- and long-distance runners with unilateral Achilles tendinitis or peritendinitis that had failed conservative treatment. Forty-eight patients were reviewed at an average of 22.1 months (SD, 6.5) after surgery. Results were rated as excellent in 25 patients, good in 12, fair in 7, and poor in 4. Four patients developed subcutaneous hematomas. One patient developed a superficial infection at one of the incision sites, which was managed by oral antibiotics with full recovery. Three patients complained of over-sensitivity to the incisions; this was resolved by rubbing hand cream over the incisions several times a day. One patient developed hypertrophic painful scars on three of the five incisions, but corticosteroid injections yielded good functional and cosmetic results. Isometric strength and endurance of the gastrocsoleus complex was measured just before the procedure, and at 6 weeks and 6 months later. Both were within 10% of the normal contralateral limb by the 6th postoperative month. Percutaneous longitudinal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, and, in our experience, has produced no significant complications. We use this procedure as the operative treatment of choice for cases of chronic tendinitis that have failed conservative treatment.
1989年8月至1995年1月，我们在局部麻醉下对52名单侧跟腱炎或腱周膜炎且保守治疗无效的中长跑运动员进行了多次经皮纵向腱切断术。48例患者在术后平均22.1个月（标准差6.5）时接受了复查。结果评定为优25例，良12例，可7例，差4例。4例出现皮下血肿。1例患者在其中一个切口部位发生浅表感染，经口服抗生素治疗后完全康复。3例患者抱怨切口过度敏感；通过每天在切口上涂抹几次护手霜得以解决。1例患者在5个切口中的3个出现增生性疼痛瘢痕，但皮质类固醇注射取得了良好的功能和美容效果。在手术前、术后6周和6个月时测量了腓肠肌复合体的等长力量和耐力。术后第6个月时，两者均在对侧正常肢体的10%以内。经皮纵向腱切断术操作简单，可在门诊进行，所需随访护理极少，且根据我们的经验，未产生重大并发症。对于保守治疗无效的慢性肌腱炎病例，我们将此手术作为首选的治疗方法。
