急性胫后肌腱断裂：基于24个案例的文献回顾

Acute tibialis posterior tendon rupture： a literature review based on 24 cases

目的研究急性胫后肌腱断裂的临床特征、治疗方案及临床转归。方法以“[（posterior tibial tendon）OR（tibialis posterior tendon）]AND（rupture OR injury OR disruption OR trauma OR tear）”为检索式，检索了PubMed数据库，筛选出胫后肌腱断裂的19篇文献包含了24个案例报告。分析其受伤机制、x线片表现、术中所见、治疗方式及预后。结果急性胫后肌腱断裂的受伤机制为交通伤（50．0％，12／24）、高处坠落伤（41．7％，10／24）、运动损伤（8．3％，2／24）；最常伴发于踝关节骨折（91．7％，22／24），尤其是旋前型（70．8％，17／24）；最常见的处理方式为直接缝合（91．7％，22／24）；95．5％（21／24）的患者预后良好。结论急性胫后肌腱断裂多发于高能量旋前型内踝骨折，受伤机制为肌腱牵拉或骨块切割．早期手术效果好。

Objective To study the clinical features, treatment methods and clinical outcomes of acute tibialis posterior tendon rupture. Methods Using ＂[ （posterior tibial tendon） OR （tibialis posterior tendon） ] AND （rupture OR injury OR disruption OR trauma OR tear）＂ as the search words, we searched the PubMed database to retrieve the 19 articles involving 24 cases of acute tibialis posterior tendon rupture. The injury mechanisms, X-ray manifestations, operational findings, treatment methods and clinical outcomes were analyzed. Results The mechanisms of the fracture-related tibialis posterior tendon rupture included motor accident （50.0%, 12/24）, falling from a height （41.7%, 10/24） and sports injury （8.3%, 12/24）. The tendon rupture was mostly complicated with malleolar fracture （91.7%, 22/24）, especially the pronation type （70.8%, 17/24）. Direct suture of the tendon was adopted in 91.7% of the cases （22/24）. Favorable out- comes were achieved in 95.5% of the cases （21/24）. Conclusions Acute tibialis posterior tendon rupture is mostly seen in high-energy medial malleolus fracture. The mechanism of the rupture might be tendon distraction or bone flake incision. Early operation can lead to favorable outcomes.