小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩23例

Treatment of achilles tendon contracture in 23 cases using Ilizarov and needle-knife technology

目的探讨小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩的疗效。方法我院2010年5月~2014年5月共收治符合条件的跟腱挛缩症患者23例。所有患者术前均测量被动背伸角度及Hannover跟腱评分,术中用小针刀联合Ilizarov踝关节牵引器治疗,术中先安装Ilizarov跨踝关节牵引器,然后用小针刀在跟腱不同平面切割1~4次,同时调整牵伸杆,直至踝关节达到中立位,8周后拆除牵引架。术后随访4~8个月。结果末次随访测量踝关节被动背伸位角度(跖屈用负数表示):于背伸位0°~10°者12例,-4°~0°者6例,-8°^-5°者5例,平均背伸(5.83±0.43)°,与术前比较,差异有统计学意义(P<0.05);术后Hannover跟腱评分为(87.2±5.6)分,与术前比较,差异有统计学意义(P<0.05);所有患者均未出现神经血管损伤及皮肤破损的并发症。结论小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩效果确切,软组织损伤小,能避免开放性跟腱延长术可能并发的创口不易愈合。

Objective TO explore the effectiveness of needle-knife and Ilizarov technology used clinically in achilles tendon lengthening in the treatment of achilles contracture syndrome. Methods From May 2010 to May 2014,23 cases of achilles contracture syndrome got treated and clinically observed retrospectively.Needle-knife and Ilizarov technology,as a possible new method, of. mini-incision achilles, tendon lengthening surgery,were synergistically used in all cases above.Ilizarov tractors over ankle were installed in the forefoot and calls.then,using needle-knife 1 to 4 limes, achilles tendon were cut in the different planes,synchronously,ankle was gradually adjusted to the neutral position by adjusting the metal threaded rod,8 weeks after surgery,the traction frames were dismantled.All patients were followed up, for 4 to 8 months. Results The passive ankle dorsiflexion angles were measured in all patients at last follow-up.While 5 cases＇ ankle jiont were in plantar flexion 5° to 8°,12 cases＇ dorsiflexion position in 0° to 10° and with an average dorsiflexion（5.83±0.43）° ;The average. Hannover achilles score was（87.2±5.6） points,between the results above of the preoperative and postoperative ,the difference was statistically significant （P〈0.05）.No severe complications such as nerve damage experienced in these patients. Conclusion Needle-knife and Ilizarov technology used synergistically in achilles tendon lengthening has the advantages of exact clieal effect,mini-incision and effectively avoiding the complications of incision healing difficultly in the traditional open achilles tendon lengthening sugery.