锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂

Anchors and peroneous brevis tendon augmentation and plantaris muscle tendon covering for the reconstruction of achilles tendon rupture caused by corticosteroids injection

目的：探讨锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂的临床疗效。方法：自2005年3月至2010年4月，采用锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂患者10例，其中男8例，女2例；年龄21—68岁，平均（46．80±2．83）岁。术后观察并发症的情况，踝关节活动范围和末次随访患足连续的足跟抬起和单腿跳的个数。跟腱功能恢复情况根据美国足踝外科协会踝一后足评分（aoFAS）评分系统进行评估。结果：10例患者获得随访，平均随访时间为13．5个月（12—18个月）。伤口均Ⅰ期愈合，无伤口感染、跟腱再断裂及排斥反应等并发症发生。末次随访时患足踝关节活动范围（54．5±6．3）°，与健足（56．8±3．8）°比较差异无统计学意义（t=0．989，P=0．336）；患足可进行10个连续的足跟抬起和单腿跳。术前AOFAS评分（67．3±7．6），与术后（95．5±7．6）比较差异有统计学意义（t=8．297，P-0．000），患足功能评分95．5±7．6，与健足98．5±6．3比较差异无统计学意义（t=0．961，P=0．349）。跟腱功能恢复情况：优9例，良1例。结论：锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂手术操作简单、固定牢固、并发症少，是一种较可靠而有效的治疗方法。

Objective ：To investigate the clinical therapeutic effects of anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering on the reconstruction of achilles tendon rupture caused by corticosteroids injection. Meth- ods： From March 2005 to April 2010,the clinical data of 10 patients with acute achilles tendon rupture repaired with suture anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering were retrospectively analyzed. The achilles tendon rupture was caused by corticosteroids injection. There were 8 males and 2 females with a mean age of （46.80±2.83） years old （ranged from 21 to 68 years ）. Postoperative complications, the range of movement of affected foot, number of consec- utive heel raises and single leg jumpings were recorded. Functional recovery of achilles tendon were assessed according to an- kle and hindfoot scores of the American Orthopedic Foot Ankle Society （AOFAS）. Results：All patients were followed up for 12 to 18 months with an average of 13.5 months. No wound infection, re-rupture and rejection reaction were found. At the last fol- low-up,there was no significant difference in the range of movement between affected foot （54.5±6.3）° and unaffected foot （56.8±3.8） ° （t=0.989,P=0.336）. The affected foot could raise heel and do single-leg hops for 10 times continuosly. There was significant difference in AOFAS between preoperative score （67.3±7.6） and postoperative score （95.5± 7.6） （t=8.297,P= 0.000） ;and there was no significant difference between affected foot scores （95.5±7.6）and unaffected foot scores （98.5±6.3） （t=0.961, P=0.349 ）. Function recovery of achilles tendon ： 9 cases were good, 1 case was fine. Conclusion： Anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering for the reconstruction of achilles tendon rupture caused by eor- ticosteroids injection is a reliable and effective method, with advantage of simple operation, dependable fixation and less compli- cations.