肌肉包埋法旷置大段裸露跟腱的初步报告

Muscle embedment spacer for large segmental exposed Achilles tendon： a preliminary report

目的探讨肌肉包埋法旷置大段裸露跟腱的手术方法和疗效。方法本组21例跟腱断裂合并跟区皮肤缺损，16例合并胫腓骨粉碎骨折及动脉、神经损伤，13例合并休克，6例合并骨盆骨折，2例合并同侧开放性股骨骨折，3例合并肝脾破裂。急诊手术固定骨折，修复动脉、神经损伤，修复肝脾破裂；清创后小腿三头肌包埋、旷置跟腱。二次手术修复跟腱和跟区皮肤缺损。结果跟腱与肌肉组织紧密粘连，外膜新鲜有光泽，腱性组织坚韧有力，无变黑、坏死、液化和感染。二次手术后随访15～27个月，平均18个月。疗效评定为优15例，良4例，差2例，优良率为90％。皮瓣均成活，伤口Ⅰ期愈合，跟腱无再次断裂。结论肌肉包埋法可以有效避免跟腱暴露所致的缺血坏死和感染，为Ⅱ期手术提供条件。

Objective to access the therapeutic methods and results of muscle embedment spacer for large segemental exposed achilles tendon. Methods There were 21 patients diagnosed as Achilles tendon rupture combined with local cutaneous deficiency, of whom 16 patients were combined with comminuted tibial fractures and artery and nerve injury, 13 combined with shock, six combined with pelvic fractures, two combined with open homolateral femoral fractures and three combined with hepatorrhexis and splenic rupture. All patients received fracture fixation and treatment for vascular and nural injuries, hepatorrhexis and splenic rupture. The ruptured Achilles tendons were embedded in the triceps surae muscle at one stage. The Achilles tendons and cutaneous deficiency were repaired at second stage. Results The embedded Achilles tendons assumed a relatively fresh and tramosericeous adventitious coat and retained good tenacity, with no signs of necrosis, colliquation or infection. The follow-up time after second operation was 15-27 months （average 18 months）, which showed excellent results in 15 patients, good in four and poor in two, with excellence rate of 90%. All skin flaps and residual wounds were primarily healed and no repaired Achilles tendons disrupted again. Conclusion The muscle embedment spacer method can largely avoid the ischemic necrosis of Achilles tendon due to long time exposure and hence provide adequate conditions for second stage operation.