跟腱挛缩的微创治疗

Minimal invasivc treatment for contraction of Achilles tendon

目的:探讨应用Ilizarov踝关节牵伸器微创治疗跟腱挛缩的方法与疗效。方法:用Ilizarov踝关节牵伸器治疗跟腱挛缩9例,手术时先将预先组装好的踝关节牵伸器套在小腿与足部,牵伸器的铰链式关节对准踝关节的关节间隙,在小腿和足部各穿2组克氏针与牵伸器的钢环固定。术后4d开始调整牵伸杆,直至踝关节达到中立位,并在此位置维持4周。结果:所有病例平均随访时间12个月,踝关节平均保持在跖屈3°位置,较术前平均改善39°,踝关节活动范围平均26°,比术前平均进步11°。无严重并发症,行走功能明显改善。结论:Ilizarov踝关节牵伸器微创治疗跟腱挛缩,能够避免一次性跟腱延长术可能出现的踝关节后部跟腱外的皮肤缺损。组织损伤小,并发症少,操作简便,安全可靠,疗效满意。

Objective： To study the technique and efficacy of Ilizarov retractor in the minimal invasive treatment for contraction of Achilles tendon. Methods： Nine patients with contraction of Achilles tendon were treated by Ilizarov retractors. The ankle retractors was assembled before surgery and put around leg and foot during the operation. The center of the hinges of the apparatus was pointed to the joint space firstly. Groups of Kirschner pin were penetrated through legs and another two groups through feet and then fixed with the steel rings of the retractors. At the fourth day after operation, traction was performed by adjusting the retractor until the ankle reached the neutral position. The retractor should hold ankle at this position for four weeks. Results： All patients were followed up for a mean of 12 months. The plantar flexion angle averaged 3 degrees after the operation and improved 39 degrees. The average range of motion of ankle reached 26 degrees and improved 11 degrees, as compared with that before the operation. No serious complications were found and the walking function improved significantly. Conclusion： Minimal invasive treatment with Ilizarov external retractor can treat contraction of Achilles tendon and avoid skin damage on the rear part of ankles caused by tendon-extending operations can be avoided. It also possesses the advantages of limited tissues damage and less complication. This method is a simple, safe and reliable therapy with satisfactory results.