腓骨长肌腱移位修复闭合性跟腱断裂

CLINICAL APPLICATION OF PERONEAL MUSCLES TENDON TRANSPOSITION IN REPAIR OF ACHILLES TENDON RUPTURE

目的探讨腓骨长肌腱移位修复闭合性跟腱断裂的应用解剖、生物力学和手术方法。方法在50侧动脉灌注红色乳胶的成人下肢标本上,观察腓骨长肌腱形态及血液供应,并进行肌腱拉伸破坏实验。设计腓骨长肌腱移位重建跟腱的术式,2001年3月~2004年7月临床应用10例闭合性跟腱断裂的患者,其中男7例,女3例;年龄32~54岁。跳跃伤6例,砸伤2例,踏空伤及自发伤各1例。新鲜伤7例,受伤至手术时间6h^7d;陈旧伤3例,受伤至手术时间21d^3个月。其中完全性断裂8例,不完全性断裂2例。结果腓骨长肌起于胫骨近端及腓骨头,止于第1跖骨基底及骰骨内侧表面,肌腱长13.5±2.5cm;起始部宽0.9±0.2cm,厚0.3±0.1cm;外踝尖平面宽0.7±0.1cm,厚0.4±0.1cm;骰骨头平面宽0.7±0.1cm,厚0.3±0.1cm。有多个血供来源。肌腱拉伸破坏实验示最大拉力:跟腱、腓骨长肌腱、腓骨短肌腱及胫骨后肌腱分别为2292.4±617.3、1020.4±175.4、752.0±165.4及938.2±216.7N。临床应用10例术后切口均期愈合;获随访18~24个月,无再断裂发生,无皮肤坏死等手术并发症。按照AmerLind-holm评定标准优7例,良3例,跟腱功能恢复良好。结论对于闭合性跟腱断裂,腓骨长肌腱移位修复跟腱是一种方法简便,疗效满意的手术方法。

Objective To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. Methods The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3 females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture（8 cases of complete rupture and 2 cases of incomplete rupture）. Results The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5±2.5 cm. The width of origin tendon was 0.9±0.2 em and the thickness was 0.3±0.1 cm; the width on apex of lateral malleolus was 0.7± 0.1 cm and the thickness was 0.4±0.1 cm, the width on head of cuboid was 0.7±0.1 cm and the thickness was 0. 3± 0. 1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2 292.4±617.3 N on tendon calcaneus, 1 020.4±175.4 N on long peroneal muscles tendon, 752.0± 165.4 N on peroneus brevis tendon and 938. 2± 216. 7 N on tibialis posterior tendon. Ten cases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 18-24 months. No Achilles tendon re-rupture, necrosis of skin or other complications occurred. According to AmerLind-holm criterion for curative results, the results were excellent in 7 cases and good in 3 cases and the excellent and good rate was 100%. Conclusion The long peroneal muscles tendon transposition is a perfect and simple way to repair occlusive Achilles tendon rupture.