胫骨后肌腱转移术研究进展

RESEARCH PROGRESS IN POSTERIOR TIBIAL TENDON TRANSFER SURGERY

胫骨后肌腱转移术是平衡足踝部肌肉力量的重要的手术方式。胫骨后肌腱转移术手术时机依据原发疾病而定,转移的路径有经骨间膜和经胫骨前内侧两种方式。经骨间膜转移有更好的生物力学、更好的踝关节范围和较少的足内翻发生率,而经胫骨前内侧转移主要适用于骨间膜存在硬化的情况。转移后的胫骨后肌腱固定至骨性结构愈合好,但不适合足部骨质差的病人。胫骨后肌腱由于长度较短,有时可能达不到预定的固定位置,此时可以通过扩大骨间膜窗口、缝合至踝关节近侧的肌腱来克服。该手术是否致平足的发生,取决于原发疾病和足踝部肌肉力量的分布。胫骨后肌腱转移至足背为不同时相的肌腱转移,同时,由于胫骨后肌腱的滑动距离较短,需要结合系统科学的康复训练,方能取得好的治疗效果。本文对近年来胫骨后肌腱转移术研究进展进行综述。

Posterior tibial tendon(PTT)transfer is an important surgical method to balance the muscle strength of foot and ankle.The surgical timing of PTT transfer depends on the primary lesion.There are two routes of PTT transfer:through the interosseous membrane(IO)and through the circumtibial route(CT).IO has better biomechanics,better ankle range,and less incidence of foot varus,while CT is mainly applicable to patients with interosseous membrane sclerosis.The transferred PTT fixed to the bone structure heals well,but it is not suitable for patients with poor foot bone quality.Due to the short length of the PTT,sometimes it may not reach the predetermined fixation point.This can be resolved by expanding the interosseous membrane window and suturing to the tendon near the ankle joint.The occurrence of flat foot after PTT transfer depends on the primary disease and the muscle strength distribution of foot and ankle.The transfer of PTT to dorsalis pedis can be performed in different phases.Moreover,due to the short sliding distance of PTT,it needs to be combined with systematic and scientific rehabilitation training to achieve good outcomes.This article reviews the research progress in PTT transfer in recent years.