经皮双向半切跟腱延长治疗跟腱挛缩症

Percutaneous achilles tendon lengthening through double hemisection in the treatment of achilles contracture syndrome

目的探讨经皮双向半切跟腱延长治疗跟腱挛缩症的方法和临床疗效。方法2006年5月至2011年11月，对59例跟腱挛缩症患者行经皮双向半切跟腱延长，其中男36例，女23例；平均年龄38．2岁；伴有足内翻42例，足外翻6例。手术分别于跟腱内外侧不同平面做两个约0．5cm纵行切口，经皮跟腱表面钝性分离，在跟腱内外侧分别切断跟腱，依据足内外翻畸形决定跟腱切断的平面，逐渐手法矫正背伸踝关节至30。，石膏托固定6周。术后随访跟腱的力量、踝背伸活动度；采用Hannover跟腱评分评分表进行功能评估。结果52例患者获得随访，7例失访，随访时间6个月-5年，平均16．5个月。48例内外翻畸形均得到有效矫正，50例患足跟着地背伸踝关节时跟腱力量较健侧无明显差异，2例较患侧相对较弱。终末随访时所有病例踝关节背伸活动度从术前（2．8±0．3）。增加至术后（28．5±1．4）°，差异有统计学意义（P〈0．05）。术后末次随访Hannover跟腱评分为（82．6±4．2）分，与术前（68．5±3．5）分比较，差异具有统计学意义（P〈0．05）。优44例，良5例，可2例，差1例，优良率为94．2％。结论经皮双向半切延长术是治疗跟腱挛缩症的有效方法，创伤小，术后恢复快。

Objective To explore the surgical approach of pereutaneous double hemisection and evaluate its clinical efficaeies. Methods From May 2006 to November 2011, a total of 59 patients were recruited. There were 36 males and 21 females with a mean age of 38.2 years （range： 8 -62 ）. Forty-two varus and 6 valgus feet underwent percutaneous double hemisection. The 0. 5 cm coraeoid incision was adopted at the medial and lateral aspects of Achilles tendon. Pereutaneous double hemiseetion was employed according to the deformity angles of varus and valgus feet. Manipulative correction was applied slowly until 30°dorsiflexion of ankle. Short leg cast was immobilized for 5 weeks at 30°dorsiflexion of ankle. The force of Achilles tendon, motion of ankle and Hannovcr Achilles tendon scores were followed up. Results Fifty-two patients were followed up for a mean period of 16. 5 months （range： 6 -60）. Seven patients were lost. At the end of follow-up, 48 patients with varus and valgus deformities were corrected effectively. When compared with the normal side, the force of Achilles of the operated side of 50 patients had no change while that of 2 patients decreased slightly; the motion of ankle joint increased from （2. 8 ± 0.3 ）° preoperatively to （28.5 ± 1.4） °postoperatively （ P 〈 0. 05 ） ; the Hannover Achilles Tendon Scores rose from （ 68. 5 ± 3.5 ） preoperatively to （ 82. 6 ± 4. 2） points postoperatively （ P 〈 0. 05 ）. The outcomes were excellent （ n = 44 ）, very good （ n = 5 ）, good （ n = 2） and poor （ n = 1 ）. The excellent and good rate was 94.2%. Conclusion As an effective therapy for Achilles tendon contracture syndrome, percutaneous double hemisection has fewer complications and a faster recovery.