同种异体肌腱移植重建跖腱膜32例

Allogenic tendon transplantation for reconstruction of plantar fascia in 32 cases

文章对承德医学院附属医院足底跖腱膜缺损的32例患者进行回顾性病例分析,所有患者应用同种异体肌腱重建跖腱膜,以期最大限度地恢复足的外观,保留足的功能。手术分2期进行:一期完成足底创面的覆盖和修复,根据患者足底损伤的情况,20例患者应用小腿内侧皮瓣修复足底创面,其余12例患者的撕脱皮瓣进行了原位缝合,在创面完全愈合后1个月,进行2期手术。2期手术根据跖腱膜的损伤情况,26例跖腱膜完全缺失的患者应用3条同种异体肌腱进行修复,其余6例跖腱膜部分缺损的患者应用2条同种异体肌腱进行了重建,修复的同时均应用钢丝进行了辅助固定。术后6周,患者扶拐下地行功能锻炼,术后6个月抽出钢丝。32例患者未出现排斥反应,创面均1期愈合。26例术后6个月复查,患者已部分负重行走,X射线平片示足弓形状维持良好;1年后复查,患者已完全负重行走,X射线平片示足弓形状维持良好;2年后复查,患足功能良好,外形满意,X射线平片示足弓形状维持良好。可见,应用同种异体肌腱重建跖腱膜,不损坏正常的组织结构,不涉及到肌腱粘连的问题,可以维持足的基本形态结构,保留足的功能,是一种可行术式。

The article retrospective analyzed the cases of 32 patients with plantar fascia defects from Affiliated Hospital of Chengde Medical College. All the patients were reconstructed plantar fascia by allogenic tendon, so as to recover the appearance and reserve the function of foot utmost. The operation was performed in two stages. （~The wound surface of foot sole was repaired at the first stage. According to the condition of foot sole injury, the wound surface was repaired by medial leg skin flap in 20 patients, and the avulsed skin flap was sutured in situ in the other 12 patients. @The second stage operation was performed at 1 month after the wound surface healed completely. According to the injury of plantar fascia, the plantar fascia that completely defect was reconstructed by 3 allogenic tendons in 26 patients, and the plantar fascia that partly defect was repaired by 2 allogenic tendons in the other 6 patients. The steel wires were used for ancillary fixation at the same time. At 6 weeks after operation, functional exercises were performed. At 6 months after operation, the steel wires were taken out. No rejection was appeared in all the patients and all wounds were healed by first intention. At 6-month follow-up after operation, 26 patients could walk by helping of crutches, and X-ray showed the foot arch maintained better. At 1-year follow-up after operation, all the patients could walk as normal, and X-ray showed the foot arch had no obvious changes. At 2-year follow-up after operation, air the patients were satisfied with the appearance and function of foot, and X-ray showed the foot arch is normal. Results suggested that reconstruction of plantar fascia by allogenic tendon can recover the structure and function of foot without sacrificing normal tissue and adhesion of tendon. So it is feasible in clinic.