足中部截肢技术与疗效分析

Techniques and results of midfoot amputation

目的总结足中部截肢技术,分析疗效,探讨肌腱平衡在足中部截肢的重要性.方法自1990年4月～1999年4月,本组行创伤性足中部截肢,包括经跖骨基底和Lisfranc截肢共26例.手术强调骨残端无须经过关节,断端需修整圆滑并形成一定的弧形.四根趾长伸肌腱留取足够长度,相互编织形成两股,分别在骨残端原肌腱方向上钻骨洞,并适当外移,肌腱残端穿越骨洞固定,重建肌腱止点.胫前肌腱骨止点如不能保留,也应保留足够长度,于骨残端前方重建肌腱止点.如果舟状骨不能保留则放弃足中部截肢.结果术后随访2～10年,平均4.5年,共15例,均无足下垂现象,踝背伸能达到或超过0°,其中4例残端有痛性胼胝,1例残端有皮肤轻度溃疡,其余效果满意.结论足中部截肢时,应考虑到不同截肢水平导致的肌力失衡,若能针对性地重建足踝的肌力平衡和良好的残端处理带来的足底生物力学平衡,将能明显减少足中部截肢的不良后果,获得较好的残肢功能.

Objective To summarize the techniques and results of midfoot amputation and discuss the role of the tendon balance in this operation.Methods Twenty-six traumatic midfoot amputions were performed from 1990 to 1999. The amputation level ranged from the base of metatarsal to the Lisfranc's joint. The bone stump should be smooth, round and arc featured, the amputation line needn't pass the joints, four extensor longus tendons were divided into two groups and the groups were weaved each other. Bone stump were drilled a hole through which extensor tendon stumps were re-attached to the bone stump. Anterior tibial tendon could also be re-attached to the front aspect of the bone stump with the above mentioned procedure. In case the navicular could not be preserved, midfoot amputation should be given up. Results Among the group, 15 cases were followed-up 2 to 10 years after operation. No case had equinovarus deformity, all cases could flex ankle dorsally to 0° or more, but 4 cases had painful callus on the stump, and 1 case slight ulceration. The other cases in the group got satisfactory outcomes. Conclusion In terms of midfoot amputation, different amputation level leads to different tendon imbalance. Proper tendon balance and appropriate stump repairing is of importance to reconstruct balanced plantar biomechanics,and then, to achieve good long term result.