V-Y肌腱瓣修补术治疗陈旧性跟腱断裂的应用解剖

Applied anatomy of treatment of old rupture of achillies tendon with V-Y tendinous flap

目的:探讨V-Y肌腱瓣修补术治疗陈旧性跟腱断裂的解剖学依据。方法:对20例成人小腿标本进行逐层解剖,测量相关解剖学数据;选取其中7例腓肠肌肌腱接近平均水平的小腿标本,制作成跟腱缺损分别为1、2、3、4、5、6、7 cm的模型,先进行断端直接吻合术,再进行V-Y肌腱瓣修补模拟手术,探讨V-Y肌腱瓣修补术的适用症。结果:正常成人跟腱最窄处平均宽度(13.25±2.73)mm,平均厚度(6.26±2.04)mm,与跟骨上方平均距离(39.52±1.25)mm。跟腱缺损2 cm以内,断端直接吻合手术能顺利进行,跟腱缺损达到3 cm,直接吻合较困难,须V-Y肌腱瓣修补术才能顺利进行,缺损达到7 cm,V-Y肌腱瓣修补术完成较困难。结论:V-Y肌腱瓣修补术适于3~6 cm以内的跟腱缺损。

Objective To provide anatomical data for surgical treatment of old rupture of Achillies tendon with V-Ytendinous flap.Methods The relevant anatomical data were measured on 20 cases of adult lower leg anatomy layer by layer specimens.Seven cases specimens of gastrocnemius tendon close to the average level of calf were made models of the Achilles tendon defect respectively 1,2,3,4,5,6,7 cm,they were firstly made a stump direct repair,furtherly made V-Ytendinous flap for repair surgery,to explore the application of the V-Ytendinous flap repair of old rupture of Achillies tendon.Results The narrowest location of Normal adults,Achilles tendon at an average width(13.25±2.73) mm,average thickness(6.26±2.04) mm,average distance to the top of the heel(39.52±1.25) mm.The Achilles tendon defect within 2 cm,The stump direct suture surgery can proceed smoothly;The Achilles tendon defect is to 3cm,the stump direct suture surgery is difficult to complete,it needs V-Y tendonous flap to repair.The Achilles tendon defect is to 7 cm,the V-Y tendinous flap repair is more difficult to complete.Conclusion V-Y tendinous flap repair is suitable for 3~6 cm within the Achilles tendon defect.