应用腓肠肌逆转筋膜瓣移植结合缝合锚固定治疗陈旧性跟腱断裂

Gastrocnemius fascial turn-down flaps combined with suture anchors for reconstruction of chronic Achilles tendon rupture

目的探讨应用腓肠肌逆转筋膜瓣移植结合缝合锚加强固定治疗陈旧性跟腱断裂的长期疗效。方法自2007年9月至2010年2月，应用腓肠肌逆转筋膜瓣移植结合缝合锚加强固定治疗陈旧性跟腱断裂患者20例，其中男13例，女7例；年龄23—50岁，平均36岁。单侧损伤19例，双侧损伤1例。肌腱缺损5—9cm，平均6．7cm。术后使用小腿支具制动，早期功能锻炼。应用Amer—Lindhohm评分以及Leppilahti评分评估疗效。结果患者术后顺利康复，无切口感染等并发症发生。20例患者均获得随访，时间30—42个月，平均38个月，末次随访时患者均可以患侧足趾踮脚站立。与健侧相比，患侧小腿肌肉力量恢复至89％。根据Amer—Lindhohm评分，患侧踝关节功能恢复优10例，良10例。Leppilahti评分平均85分（60—100分），优9例，良10例，可1例。结论应用腓肠肌逆转筋膜瓣重建跟腱并以缝合锚加强固定治疗陈旧性跟腱断裂，固定强度高，术后患者可早期功能锻炼，可有效避免肌腱粘连，功能恢复良好。

Objective To investigate the long-term results of gastrocnemius fascia] turn-down flaps and suture anchors in reconstruction of chronic Achilles tendon rupture. Methods From Septem- ber 2007 to February 2010, 20 patients with chronic Achilles tendon rupture were reconstructed with gas- trocnemius fascia] turn-down flaps plus suture anchors. There were 13 males and 7 females at mean age of 36 years （range, 23-50 years）. Unilateral tendon rupture was observed in 19 patients and bilateral in 1 patient. Tendon defect gap was 5-9 cm （ mean 6.7 cm）. Braces were used to immobilize the lower lim- ber, and early exercise was encouraged. The outcomes were assessed using Arner-Lindhohm scoring sys- tem and Leppilahti scoring system. Results Postoperative recovery was uneventful. No patients experi- enced cut infection or other complications. After a mean 38-month follow-up （range, 30-42 months） , all patients could stand on the injured toes. Muscular strength of the affected lower limber was restored to 89% of the unaffected side. According to the Arner-Lindhohm score, 10 patients were rated as excellent and ten good. Mean Leppilahti score was 85 points （range, 60-100 points） , with excellent results in nine patients, good results in 10 and fair result in one. Conclusion For patients with chronic Achilles ten- don rupture, the reconstructing using gastrocnemius fascia] turn-down flaps combined with suture anchors can attain rigid fixation, early functional exercise, effective prevention of tendon adhesion, and good func- tion recovery.