跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效

Curative Effect of Lengthening and Forward of Achilles Tendon on Treating Spastic Equinus of Children with Cerebral Palsy

目的评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效。方法收集1998年5月-2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足。男28例45足,女25例40足;年龄2.5～14.0岁,平均6.8岁。痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足。患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形。合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正。结果患儿均获随访,随访时间0.5～11.2 a,平均2.3 a。1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降。53例85足均获满意疗效,优55足,良30足,优良率达100%。结论跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法。

Objective To evaluate curative effect of lengthening and forward of achilles tendon on treating spastic equinus of children with cerebral palsy. Methods Fifty -three patients （85 feet） with spastic equinus caused by cerebral palsy in children, including 28 male （45 feet） and 25 female （40 feet） ,were treated with lengthening and forward of achilles tendon from May 1998 to Jun. 2011. The ages of the patients ranged from 2.5 to 14.0 years. According to the Ashworth method for the evaluation of spasticlty ： 12 feet belonged to level 3,38 feet level 4, and 35 feet level 5. All patients were able to walk, had normal intelligence and muscle strength of lower limbs, varying degrees of mus- cle tension,tendon reflexes hyperfunction,ankle clonus and Babinski sign positive,had not significant bone deformity in X- ray film;5 cases of double hip adduction deformity and 2 cases of double knee flexion deformity were operated in the preoperative or simultaneous. Results All patients were available for an average duration of follow - up of 2.3 years （ ranged 0.5 - 11.2 years）. One patient with incision dehis- cence and rupture of achilles tendon after 2 weeks had good recovery after treatment. Muscle strength of triceps surae was not weakened in all the patients after operation compared preoperatively. Fifty - three patients （ 85 feet） were satisfied with the effect, 55 feet were assessed as good ,30 feet as fair, the rate of good and fair was 100%. Conclusions The operation of lengthening and forward of achilles that the end of achilles tendon is moved forward to trailing edge of talocalcaneal joint on the basis of the achilles tendon extended is based on the biomechanical principles, which helps shortens the lever arm of achilles tendon to the ankle, and balances the muscle strength of extension and flexion of ankle. Its long term effect is good and it is a better approach to spastic equinus in children.