Endobutton联合双束长屈肌腱解剖止点重建治疗陈旧性跟腱断裂

Anatomic reconstruction of Achilles tendon for the treatment of chronic Achilles tendon rupture by Endobutton and double-bundle flexor hallucis longus

背景:陈旧性跟腱断裂是足踝外科的常见疾病,目前临床以手术治疗为主。长屈肌腱常被移植用作跟腱的修复,但存在单束重建时腱体单薄、双束重建时长度不足等问题。目的:观察Endobutton联合双束长屈肌腱于跟腱解剖止点重建跟腱治疗陈旧性跟腱断裂伤的临床疗效。方法:2010年1月至2011年6月,对21例MyersonⅢ型陈旧性跟腱断裂伤患者采用自体长屈肌腱移植、双束长屈肌腱联合Endobutton跟腱解剖止点重建的方法进行治疗。男16例,女5例,年龄33～47岁,平均39.5岁。均为闭合性跟腱断裂。随访包括临床评价、X线及MR检查,采用美国足踝外科协会(American Orthopaedic Foot&Ankle Society,AOFAS)踝与后足评分以及Leppilahti跟腱修复评分标准进行术后疗效评定。结果:21例获得平均16个月随访(12～30个月)。AOFAS-AH评分从术前63.2±8.3分提高到93.5±8.1分;Leppilahti跟腱修复评分从术前71.5±9.1分提高到93.2±5.9分。所有患者均无神经损伤、切口感染等并发症。术后6个月X线示Endobutton固定位置良好,MRI示移植肌腱位置及形态良好。结论:Endobutton联合双束长屈肌腱解剖止点重建的方法可为跟腱提供强度和长度更为满意的自体移植物,术后功能恢复良好,无明显并发症。

Background： Chronic Achilles tendon rupture is a common disease in foot and ankle surgery and mainly treated by opera- tion. Flexor hallucis longus （FHL） is often used as self-allograft to repair Achilles tendon. But the tendon with single-bundle reconstruction is slender and the tendon is very short with double-bundle reconstruction. Objective： The pta＇pose of the study is to observe the clinical outcomes of anatomic reconstruction of chronic Achilles ten- don rupture by Endobutton and double-bundle FHL. Methods： From January 2010 to June 2011, 21 patients with Myerson III type chronic Achilles tendon rupture were treated by autologous FHL transplantation and anatomic reconstruction with Endobutton and double-bundle FHL. The curative ef- fect was assessed by clinical evaluation, X-ray and MRI examination, American Orthopaedic Foot ＆ Ankle Society-Ankle and Hindfoot Score （AOFAS-AH） and Leppilahti score. Results： All the 21 patients were followed up for 12 to 30 months （mean, 16 months）. The average AOFAS-AH score in- creased from 63.2±8.3 preoperatively to 93.5±8.1 postoperatively. Leppilahti Achilles Tendon Repair score increased from 71.5±9.1 preoperatively to 93.2±5.9 postoperatively. No nerve injury and incision infection occurred. X-ray showed the En- dobutton was in the proper site and MILl scan showed the position and shape of FHL tendon was also good at 6 months after the operation. Conclusions： Endobutton and double-bundle FHL can provide a more suitable autologous graft in strength and length for the treatment of chronic achilles tendon rupture. Functional recovery of ankle is satisfactory and no main complications will happen after operation by this method.