踇长屈肌腱转位联合腓肠肌瓣V-Y延长术治疗陈旧性跟腱断裂

Flexor hallucis tendon transfer combined with gastrocnemius flap V-Y lengthening for old Achilles tendon rupture

目的探索踇长屈肌腱转位联合腓肠肌瓣V—Y延长术治疗陈119性跟腱断裂的疗效。方法对2010年2月至2014年2月收治的21例陈旧性跟腱断裂患者（KuwadaⅢ型15例、KuwadalV型6例）进行踇长屈肌腱转位联合腓肠肌瓣V-Y延长术重建跟腱，采用美国足踝外科协会（AOFAS）踝-后足评分系统、Leppilahti跟腱修复评分系统进行疗效评价。结果对所有术后患者随访18～36个月，术后切口Ⅰ期愈合，未出现切口感染、跟腱再断裂、周围神经血管损伤、皮肤坏死等并发症。AOFAS踝-后足评分由术前（52．44±12.75）分明显提高至术后末次随访的（91．02±6．85）分（P〈0．01），Leppilahti跟腱修复评分由术前（34．33±12．92）分明显提高至术后末次随访的（90．95±5．10）分（P〈0．01）。结论踇长屈肌腱转位联合腓肠肌瓣V-Y延长术治疗KuwadaⅢ型、部分KuwadaⅣ型陈旧性跟腱断裂，能明显恢复踝关节功能，具有疗效确切、操作简单、并发症少等优点。

Objective To evaluate the efficacy of hallux Iongus tendon transfer combined with gastrocnemius flap V-Y lengthening in treatment of old Achilles tendon rupture. Methods Twenty one patients with old Achilles tendon rupture were treated in our hospital from February 2010 to February 2014 with hallux Iongus tendon transfer combined Gastrocnemius flap V-Y lengthening to rebuild Achilles tendon. The efficacy was assessed according to the American Association of Foot and Ankle Surgery （AOFAS） the Ankle-Hind foot score system, Leppilahti Achilles tendon repair scoring system. Results All cases were followed up for 18-36 months. The postoperative incision achieved primary healing in all patients; no postoperative complications were observed including wound infection, Achilles tendon re-rupture, peripheral nerve and vessels damage and skin necrosis. AOFAS scores were significantly increased from 52.44± 12.75 before operation to 91.02 ± 6.85 by end of postoperative follow-up （P〈0.01）.Leppilahti Achilles tendon repair scores were increased significantly from 34.33± 12.92 before operation to 90.95± 5.10 by end of postoperative follow-up （P〈0.01）. Conclusion The Hallux Iongus tendon transfer combined gastrocnemius flap V-Y lengthening can significantly restore ankle joint function in treatment of Kuwada Ⅲ type, part of Kuwada Ⅳ type old Achilles ten- don rupture with fewer complications.