改良腓骨肌沟加深联合腱鞘修补术治疗腓骨肌腱滑脱症

Modified retromalleolar groove deepening combined with tendon sheath repair in treatment of peroneal tendon dislocation

背景:腓骨肌腱滑脱症临床上并不常见,目前尚无最佳手术方案的共识。目的:探讨改良腓骨肌沟加深联合腱鞘修补术治疗腓骨肌腱滑脱症的临床疗效。方法:回顾性分析2013年9月至2018年3月收治的采用改良腓骨肌沟加深联合腱鞘修补术治疗的腓骨肌腱滑脱患者14例。对患者术前及随访期间疼痛视觉模拟评分(VAS)和美国足踝外科协会踝与后足评分(AOFAS-AH)进行评估。结果:14例患者均顺利完成手术,手术时间50~80 min。所有患者手术切口均甲级愈合,未发生切口感染、皮肤坏死及神经血管损伤等并发症。14例患者均获得随访,随访时间15~69个月。末次随访时患者疼痛VAS评分、AOFAS-AH评分均较术前改善,且差异均有统计学意义(t=10.33、-28.67,P均<0.001)。末次随访时AOFAS-AH评分为84~100分,其中12例患者为优,2例为良,优良率为100%。所有患者步态均正常。结论:改良腓骨肌沟加深联合腱鞘修补术治疗腓骨肌腱滑脱症操作简单、损伤小,无需内固定,疗效确切。

Background: Peroneal tendon dislocation is not common clinically, and there is no consensus on the best surgical program. Objective: To investigate the clinical curative result of modified retromalleolar groove deepening combined with tendon sheath repair for peroneal tendon dislocation. Methods: From September 2013 to March 2018, 14 patients with peroneal tendon dislocation were treated by modified retromalleolar groove deepening combined with tendon sheath repair. Visual analogue scale(VAS) and American Orthopaedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AH) were evaluated before and after surgery. Results: The operation was successfully performed in all the 14 patients, and operation time ranged from 50 to 80 min. All surgical incisions healed well, and there were no complications such as infection, skin necrosis or neurovascular injury. Fourteen patients were followed up for 15 to 69 months. AOFAS-AH and VAS scores were significantly improved at the last follow-up compared with preoperative ones(P<0.001). AOFAS-AH score was 84 to 100 at the last followup, including excellent in 12 cases and good in 2 cases;all patients walked with normal gait. Conclusions: Modified retromalleolar groove deepening combined with tendon sheath repair has the advantages of simple operation, small trauma, no need of internal fixation and satisfactory curative effect.