长屈肌腱转位手术治疗老年跟腱断裂的疗效分析

Clinical outcomes of flexor hallucis longus tendon transfer inClinical inelderly patients with Achilles tendon ruptureselderly ruptures

背景：慢性跟腱疾病发展到后期往往需要行肌腱转位治疗，长屈肌腱转位手术是常用的治疗方式。但老年患者的功能恢复、生活方式有别于其他人群。目的：探讨长屈肌腱转位手术治疗老年人跟腱断裂的临床效果。方法：回顾性分析2007年9月至2012年7月在我院行长屈肌腱转位手术的老年患者的病例资料（＞60岁）。共14例（16足），男女各7例，年龄60~83岁，平均67.1岁。2例女性患者为双侧跟腱断裂同时行手术修补，均采用单切口长屈肌腱转位替代跟腱疗法。分别评估患者术前与术后美国足踝外科协会踝-后足评分（AOFAS-AH），美国足踝外科协会趾-跖趾-趾间关节评分（AOFAS-MTPIP），视觉模拟法（VAS）疼痛评分，跟腱断裂评分（ATRS）及手术相关并发症情况。最后进行统计学比较，评价患者足踝部功能恢复情况及患者满意情况。结果：14例患者术后获得21~67个月随访。AOFAS-AH评分从术前（68.2±6.2）分提高到术后的（93.2±5.3）分；AOFAS-MTPIP评分术前为（94.2±2.9）分，术后为（95.1±3.2）分；VAS评分术前（5.1±1.4）分，术后为（1.0±0.7）分；ARTS评分从术前（52.7±9.3）分提高到术后（86.3±10.3）分。16足术后均未出现伤口感染等手术并发症，也未在围手术期出现肺部感染、深静脉血栓等其他并发症。结论：长屈肌腱转位手术在老年人中的应用不但具有很好的手术疗效，并且安全性较高。

Background：Tendon transfer is essential to treat end-stage chronic Achilles tendon diseases. Flexor hallucis longus （FHL） tendon transfer is one of the most popular treatments. However, functional recovery and life style in elderly people are dif-ferent from others. Objective：This study is aiming to explore the outcomes of FHL tendon transfer in the elderly patients who suffered from Achilles tendon ruptures. Methods：We retrospectively studied 14 cases （16 feet） who underwent FHL tendon transfer for reconstruction of Achilles tendon between September 2007 and July 2012. Among them there were 7 males and 7 females aged from 60 to 83years （mean age, 67.1 years）. American Orthopaedic Foot and Ankle Society ankle-hindfoot scale （AOFAS-AH）, AOFAS hallux and metatarsophalangeal-interphalangeal scale （AOFAS-MTPIP）, visual analogue scale （VAS）, Achilles tendon rupture score （ATRS） were assessed before and after surgery to evaluate the functional recovery. Complications were recorded. Results： The duration of follow-up ranged from 21 to 67 months in the 14 patients. The average AOFAS-AH score in-creased from 68.2±6.2 preoperatively to 93.2±5.3 postoperatively;the average AOFAS-MTPIP score increased from 94.2± 2.9 preoperatively to 95.1±3.2 postoperatively. The average VAS score was 5.1±1.4 at the last follow-up, which was signifi-cantly lower than that before operation （1.0±0.7）. ATRS increased from 52.7±9.3 preoperatively to 86.3±10.3 postoperative-ly. No complications, such as incision infection, pulmonary infection or venous thromboembolism happened. Conclusions：FHL tendon transfer is an efficient procedure for Achilles tendon ruptures in elderly people.