微创切取全长足母长屈肌腱重建陈旧性KuwadaⅣ型跟腱断裂

Clinical efficacy of reconstruction for chronic achilles tendon rupture of Kuwada IV type with flexor hallucis longns harvested using a minimally invasive technique

目的探讨微创切取全长躅长屈肌腱重建陈旧性KuwadaIV型跟腱断裂的临床效果。方法回顾性分析2006年7月至2011年6月，微创切取全长躅长屈肌腱重建35例陈旧性KuwadaIV型跟腱断裂患者资料，男21例，女14例；年龄为23-71岁，平均42．1岁；均为单侧损伤。MRI示跟腱断裂间隙为6．0-9．2cm。观察术后踝关节外形及功能恢复情况，并采用美国足踝外科协会（AmericanOr-thopaedicFootandAnkleSociety，AOFAS）踝与后足评分及Leppilahti跟腱修复评分评价疗效。结果32例获得随访，随访时间为18-72个月，平均33．2个月。除1例患者因术后10d拆线致切口裂开重新缝合6周后获得延迟愈合外，其余患者切口均一期愈合。术后踝关节外形及功能恢复良好，AOFAS踝与后足评分从术前（51．92±7．08）分提高到术后（92．56±6．71）分；其中优27例，良3例，可2例，优良率为93．8％（30／32）。Leppilahti跟腱修复评分从术前（72．56±7．43）分提高到术后（92．58±5．1）分。无一例发生腓肠神经及胫神经损伤、跖部痛性瘢痕、足底内外侧神经损伤。踩关节MRI示跟腱部信号均匀无撕裂和囊性变。结论微创切取罡母长屈肌腱转移重建陈旧性KuwadalV跟腱断裂具有术后恢复快、肌腱固定强度高、并发症少的优点。

Objective To explore clinical effect of reconstruction for chronic Achilles tendon rupture of Kuwada IV type with flexor hallueis longus （FHL） harvested using a minimally invasive technique. Meth- ods The data of 35 patients with chronic Achilles tendon rupture of Kuwada IV type was retrospectively analyzed who were treated by FHL which was harvested using a minimally invasive technique from July 2006 to June 2011. There were 21 males and 14 females, with the age from 23 to 71 years （average, 42.1 years）. All patients were unilateral injury. MRI showed Achilles tendon rupture fissures 6.0-9.2 cm. The local ap- pearance and function recovery on postoperation was observed, and all patients were assessed with the Amer- ican Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and Leppilahti Achilles tendon repair score. Results Thirty-two patients were followed up for 18 to 72 months, with an average of 33.2 months. Except for 1 patient whose wound healed after six weeks through resuture immediately for the wound dehis- cence occurred in the ten days, other patients＂ wound healed smoothly. The average of AOFAS ankle-hindfoot score had increased from 51.92±7.08 preoperatively to 92.56±6.71 postoperatively. Leppilahti Achilles tendon repair score had increased from 72.56±7.43 preoperatively to 92.58±5.1 postoperatively. Twenty-seven cases were excellent, good in 3, and fair in 2, with the total excellent and good rate 93.8% （30/32）. No case of the sural nerve and tibial nerve injury, plantar painful scar, plantar outside nerve injury. MRI of Achilles tendon showed even signal without signal of tear and cystic degeneration. Coneluslon Reconstruction for chronic Achilles tendon rupture of Kuwada IV type with FHL harvested using a minimally invasive technique offers a desirable outcome in rapid postoperative recovery, high strength in tenodesis, fewer complications.