胫后肌腱前移术矫治麻风垂足的远期效果

Long-term results of posterior tibialis muscle transfer for foot-drop in leprosy

目的 : 了解胫后肌腱前移术矫治麻风垂足的远期效果。方法 : 近 3年随访了 1985～ 1996年部分手术患者 ,对其 80例 82只足的步态、踝关节主动背屈、跖屈功能、移位肌肌力变化、有无足部畸形、溃疡发生以及患者对手术疗效的满意度等进行检查和记录 ,并结合标准综合评定手术疗效。结果 : 随访82只足中 ,远期效果优 5 1足、良 17足、尚可 12足及无效 2足。其中 :移位肌止于骨孔 37足中 ,优良 31足 ,2足移位肌腱滑脱。移位肌止于肌腱的 4 5足中 ,优良 37足 ,3足发生轻度的内翻 ,2足出现垂趾 ,2足肌腱止点处皮下粘连 ,3足发生溃疡 ,3足内翻复发。骨间膜法与皮下隧道法不论移位肌的止点是骨孔还是肌腱其术后优良足无差异 (P >0 .0 5 )。结论 : 胫后肌腱前移术加跟腱延长术矫治麻风垂足可获得优良的远期效果 ,选择移位肌腱路径及止点应依据垂足合并足内翻的程度、垂趾以及骨质疏松的有无 ,胫腓骨下段间隙的大小来确定。手术前。

Objective:To determine the long-term results of the posterior tibialis transfer in the treatment of foot-drop in leprosy.Methods:The patients who received the posterior tibialis transfer operation during 1985 and 1996 were followed-up in the past three years. Walking gait, active dorsiflexion and plantar flexion of the ankle joint, deformities or ulceration of the feet, and patient's satisfaction were recorded. Results: Of the 80 cases (82 feet) followed-up, excellent results were obtained in 51 feet, good in 17 feet, fair in 12 feet, and poor in 2 feet. Among 37 feet, which had interosseous transfer, excellent-or-good results were obtained in 31 feet, while 2 tendons avulsed postoperatively. Among 45 feet, which had circumtibial transfer, excellent-or-good result was obtained in 37 feet, while 3 developed new inversion, 2 toe-drops, 2 tendon adhesion subcutaneously, 3 with ulceration, and 3 had recurrent inversion. There was no significant difference in the excellent-or-good results between the groups of interosseous transfer and circumtibial transfer, and whether the transferred tendon attaching to bone or tendon (P>0.05). Conclusion:Posterior tibialis transfer with elongation of Achilles tendon gives excellent or good results in foot-drop due to leprosy. The route and attachment point of the transferred tendon should be selected based on whether the foot complicated by inversion, toe-drop, or osteoporosis, and also the interosseous space size. Physical exercises are emphasized to carry out pre-and-postoperatively.