Markarian G G, Kelikian A S, Brage M, Trainor T, Dias L
Edward Hospital, Naperville, Illinois, USA.
Foot Ankle Int. 1998 Dec;19(12):792-802. doi: 10.1177/107110079801901202.
Ruptures of the anterior tibialis tendon are a rare clinical entity. Case reports in the literature reveal a total of 28 cases. Unfortunately, because of the limited discourse in the orthopaedic literature, there are few guidelines regarding the treatment for these injuries. This study analyzes the treatment of 16 anterior tibialis tendon ruptures. Eight patients in this group had operative treatment of their ruptures, and eight patients had nonsurgical treatment of their ruptures. The average follow-up for the operative and nonoperative patients were 6.68 years and 3.86 years, respectively. The Foot and Ankle Outcome questionnaire provided by the American Academy of Orthopaedic Surgeons and an outcome-based foot score described by Kitaoka et al. were used as the methods of analysis. Our outcome results show no statistically significant difference between operative and nonoperative treatment in anterior tibialis tendon ruptures. The lack of statistical difference between operative and nonoperative groups may be a reflection of the age bimodality present in this study. Elderly low demand patients were treated nonsurgically and young active patients were treated operatively. Therefore, despite a lack of statistical difference present in the outcome of both groups, we still maintain the need to repair/reconstruct anterior tibialis tendon ruptures in young active patients with high functional demands. The deficits present in the nonoperative group, we believe, would not be well tolerated in a young high functional demand patient. Nonsurgical management is an appropriate alternative in low demand elderly patients.
胫前肌腱断裂是一种罕见的临床病症。文献中的病例报告总共显示有28例。遗憾的是，由于骨科文献中对此论述有限，关于这些损伤的治疗几乎没有指南。本研究分析了16例胫前肌腱断裂的治疗情况。该组中有8例患者接受了手术治疗，8例患者接受了非手术治疗。手术患者和非手术患者的平均随访时间分别为6.68年和3.86年。采用美国矫形外科医师学会提供的足踝结果问卷以及Kitaoka等人描述的基于结果的足部评分作为分析方法。我们的结果显示，胫前肌腱断裂的手术治疗和非手术治疗之间在统计学上没有显著差异。手术组和非手术组之间缺乏统计学差异可能反映了本研究中存在的年龄双峰性。老年低需求患者接受非手术治疗，年轻活跃患者接受手术治疗。因此，尽管两组结果在统计学上没有差异，但我们仍然认为，对于功能需求高的年轻活跃患者，修复/重建胫前肌腱断裂是必要的。我们认为，非手术组出现的功能缺陷在功能需求高的年轻患者中是无法很好耐受的。非手术治疗是低需求老年患者的一种合适选择。
