微创技术在陈旧性跟腱断裂治疗中的进展与思考

Progress and thinking of minimally invasive technique in the treatment of chronic Achilles tendon rupture

近年来,微创技术在治疗陈旧性跟腱断裂中的应用日趋成熟,同时也面临着诸多的争议和挑战。微创技术的理念在于尽可能减少对跟腱周围软组织的剥离,减少术后伤口并发症的发生。微创小切口手术不暴露跟腱断端,可完成肌腱转位、肌腱移植等复杂手术,但存在误伤周围神经的风险。关节镜技术治疗陈旧性跟腱断裂的方法主要有关节镜下踇长屈肌腱转位、关节镜下肌腱桥接两类,前者对术后踇趾屈曲力量有一定影响,后者在大段缺损中应用较多。科学合理地将微创技术应用于陈旧性跟腱断裂患者的治疗,是未来足踝外科医师不断研究的目标和方向。

In recent years,the application of minimally invasive techniques in the treatment of chronic Achilles tendon rupture has become more and more mature,and it also faces many controversies and challenges.The concept of minimally invasive technique is to minimize the dissection of soft tissue around the Achilles tendon and reduce the occurrence of postoperative wound complications.Minimally invasive small incision surgery does not expose the Achilles tendon stump,and either tendon transposition or tendon transplantation can be achieved using this technique,but there is a risk of accidental injury to the peripheral nerve.There are two main categories of arthroscopic treatment of old Achilles tendon rupture:endoscopic flexor hallucis longus tendon transfer and endoscopic tendon bridging.The former has a certain effect on postoperative flexor digitorum strength,and the latter is used in large segment defects mostly.The scientific and reasonable application of minimally invasive techniques in the treatment of patients with chronic Achilles tendon rupture is the goal and direction of continuous struggle of foot and ankle surgeons in the future.