吻合血管髂胫束移植修复跟腱缺损

REPAIR OF ACHILLES TENDON DEFECT BY TRANSPLANTATION OF ILIOTIBIAL BAND WITH VASCULAR ANASTOMOSES

目的 探讨带血管的髂胫束游离移植修复跟腱缺损的术式及疗效。 方法 在解剖观测髂胫束的血供来源及膝上外侧动脉的起源、走行、分支、分布及吻合的基础上 ,进行手术设计。 1999年 9月～ 2 0 0 3年 1月应用吻合血管的髂胫束修复长段跟腱缺损 6例 ,其中单纯跟腱缺损 4例 ,复合跟腱缺损 2例 ,缺损长度 6～ 11cm。 结果 膝上外侧动脉起自动脉 ,向外上走行分为升、降支。升支发出肌支和髂胫束穿支 ;膝上外侧动脉升支与膝最上外侧动脉在股外侧肌内吻合后穿出股外侧肌形成肌皮穿支。降支发出肌支、3～ 5支股骨外侧髁骨膜支及髂胫束穿支。术后供、受区创面均一期愈合。随访 6个月～ 3年 8个月个月 ,Thompson征阴性 ,双、单足提踵试验阴性。无跟腱再断裂、跟区皮肤破溃等并发症发生。结论 根据膝上外侧血管的分支、分布及吻合特点 。

Objective To discuss a new operative procedure and the results of transplantation of iliotibial band with vascular anastomoses to repair Achilles tendon defect.Methods The origin, course, branches, distribution and anastomoses of the lateral superior genicular artery and blood supply of iliotibial band were observed on adult lower limbs perfused with red latax. From September 1999 to January 2003, 6 cases of Achilles tendon defects were treated with transplantation of the vascularized iliotibial band by use of microsurgical technique . The area of Achilles tendon defect was 6-11 cm. Six cases of Achilles tendon defects included 4 simple defects and 2 defects with skin defects.Results The lateral superior genicular artery originated from the popliteal artery and divided into the ascending branch and descending branch .The ascending branch gave off muscular branch and perforating rami of iliotibial band. The lateral superior genicular artery anatomosed the lateral uppermost genicular artery in the vastus lateralis muscle, and then formed the musculocutaneous perforating rami of iliotibial band. Six patients treated with transplantation of iliotibial band with vascular anastomoses were followed up 6-44 months. The results showed significant improvement in “heel test” and Thompson sign. No complication of ulcer on heel and rerupture of the Achilles tendon occurred.Conclusion The vascularized iliotibial band is a good donor in reconstruction of Achille tendon defect.