自体肌腱移植修复陈旧性跟腱损伤

Repair of old Achilles tendon rupture by tendon autografts

[目的]评价自体肌腱移植修复陈旧性跟腱损伤的临床疗效。[方法]回顾性分析2016年7月—2021年10月自体肌腱移植修复陈旧性跟腱损伤7例患者的临床资料,评价围手术期及随访结果。[结果]所有患者术程顺利,手术时间(106.4±13.6)min,术中出血量(35.3±12.3)ml,断端缺损(5.1±2.1)cm,住院时间平均(11.6±1.3)d。所有患者切口均Ⅰ期愈合。随访时间(46.1±19.6)个月。随着术前、术后6个月和末次随访的时间推移,VAS评分显著减少[(2.9±0.9),(1.7±0.8),(0.6±0.5),P<0.001],AOFAS评分[(57.4±10.0),(81.1±4.5),(95.1±4.0),P<0.001]、踝ROM[(27.4±3.0)°,(50.3±3.3)°,(56.6±3.5)°,P<0.001]、ATRS评分[(41.1±5.8),(71.6±4.4),(93.3±4.2),P<0.001]均显著增加,三头肌肌力[例,Ⅲ/Ⅳ/Ⅴ,(7/0/0),(0/2/5),(0/0/7),P<0.001]显著改善。[结论]对于陈旧性跟腱损伤,应用腓骨长肌腱或半腱肌移植修复仍可取得满意的临床疗效。

[Objective]To evaluate the clinical efficacy of repair of old Achilles tendon injury with tendon autografts.[Methods]A ret⁃rospective study was conducted on 7 patients who had old Achilles tendon rupture repaired by tendon autografts from July 2016 to October 2021.The documents regarding to perioperative period and follow-up were evaluated.[Results]All patients had Achilles tendon repaired smoothly with operation time of(106.4±13.6)min,intraoperative blood loss of(35.3±12.3)ml,tendon defect of the broken end of(5.1±2.1)cm,and hospital stay of(11.6±1.3)days.All patients got incision healed in stageⅠand followed up for(46.1±19.6)months.As time went from the point preoperatively,6 months postoperatively to the latest follow-up,the VAS score significantly reduced[(2.9±0.9),(1.7±0.8),(0.6±0.5),P<0.001],whereas AOFAS score[(57.4±10.0),(81.1±4.5),(95.1±4.0),P<0.001],ankle ROM[(27.4±3.0)°,(50.3±3.3)°,(56.6±3.5)°,P<0.001],ATRS score[(41.1±5.8),(71.6±4.4),(93.3±4.2),P<0.001]significantly increased,and triceps muscle strength[case,Ⅲ/Ⅳ/Ⅴ(7/0/0),(0/2/5),(0/0/7),P<0.001]improved significantly.[Conclusion]For the old Achilles tendon rupture,repair with tendon autografts,such as peroneus longus or semitendinosus,can still achieve satisfactory clinical consequence.