陈旧性跟腱断裂的手术治疗

Surgical treatment of the neglected achilles tendon rupture

目的探讨陈旧性跟腱断裂的手术治疗方法。方法 2005年9月至2016年8月,手术治疗陈旧性跟腱断裂17例(均为单侧),男11例,女6例;年龄23~85岁,平均58岁。采用的手术方法为:清创后缺损<2 cm者牵引后直接端端缝合,2~5 cm者行长屈肌腱转位桥接跟腱缺损,5~8 cm者行长屈肌腱转位联合腓肠肌延长。结果 15例患者获得12~48个月随访,平均20个月,切口均Ⅰ期愈合。平均术后13周(11~14周)时可完全负重行走,无明显疼痛及行走不适。采用美国足踝外科协会(AOFAS)踝-后足评分标准,评分为83~100分,平均94.14分。跟腱断裂的ATRS评分81~100分,平均90.93分。结论陈旧性跟腱断裂通过恰当的手术治疗可获得良好的修复重建和功能恢复。

Objective To explore the operative treatment for the neglected achilles tendon ruptures.Methods Seventeen patients of neglected achilles tendon ruptures were treated from September 2005 to August 2016.There were 11 males and 6 females with an average age of 58 years(ranged from 23 to 85 years).The surgical treatments included simple end-to-end anastomosis,V-Y myotendinous lengthening,flexor hallucis longus tendon transfer.Results Fifteen patients were followed up for average 20 months(ranged from 12 to 48 months).All of the incisions have healed well and no infection was found.The mean time of completely weight loading walking was 13 weeks(ranged from 11 to 14 weeks).According to AOFAS the ankle-hindfoot scale,the mean score is 94.14(ranged from 83 to 100).The mean ATRS score at the last follow-up was 90.93(ranged from 81 to 100).Conclusion Good anatomical and functional reconstruction can be achieved by proper operative treatment.