骨外固定牵引架联合跟腱延长矫治重度瘢痕性跟腱挛缩畸形

Correction of deformity of cicatricia achilles tendon with externalfixator and tendon lengthening

目的:探讨骨外固定牵引架联合跟腱延长术矫治重度瘢痕性跟腱挛缩畸形的临床治疗效果,为重度跟腱挛缩畸形提供新的治疗思路。方法:2004年3月～2008年10月,对9例重度瘢痕性跟腱挛缩患者进行矫治。手术分两期进行,第一期手术设计跟腱瘢痕瓣行跟腱延长术,同时上骨外固定牵引架,创面碘仿纱布覆盖,然后进行外固定支架牵引矫治跟腱挛缩畸形,待踝关节达到合适角度后,进行第二期手术,采用中厚皮片修复创面。结果:所有9例患者,跟腱挛缩畸形均得到良好的矫治,8例患者跟腱瘢痕瓣存活良好,1例患者出现不同程度的远端坏死,在第二期手术时一并修复,术后加强功能锻炼,术后随访3月～26月,直立行走活动自如。结论:采用骨外固定牵引架联合跟腱延长术矫正重度跟腱挛缩畸形的方法,避免了骨关节及血管神经损伤等并发症,较快地矫正踝关节至功能位,短时间恢复患者下地行走,可以作为重度跟腱挛缩畸形的理想治疗方法之一。

Objective To investigate the treatment effect of correction of cicatricia achilles tendon deformity with externalfixator and tendon lengthening, and provide a new treatment clue for severe achilles tendon deformity. Methods From Mar. 2004 to Oct. 2008, 9 patients （11 feet） with severe achilles tendon deformity were treated with cicatricial achilles tendon flap and externalfixator. The procedure composed of two stages, at the fist stage, the achilles tendon Iongening was exercised with cicatricial achilles tendon flaps, and then the externalfixators were placed. At the second stage, the wounds were repaired with skingrafting. Results Achilles tendon deformity was corrected in all 9 patients, cicatricial achilles tendon flaps survived well in 8 patients, external part necrosis of cicatricial achilles tendon flap was occurred in only 1 patients, and then repaired at the second stage. Functional exercise was strengthened after surgery. After 3-26months follow-up, all of the patients could walked freely and were satisfied with the operation results. Conclusions The correction method of cicatricia achilles tendon deformity with externalfixator and tendon lengthening can be used as a ideal treatment for severe achilles tendon deformity, which can avoid the complications of bone and joint and vessel and nerve, and can correct the ankle to functional position for walk very soon.