全关节镜下[⻊母]长屈肌腱转位治疗老年陈旧性跟腱断裂的效果分析

Arthroscopic repositioning of the flexor hallucis longus tendon in the treatment of chronic achilles tendon rupture in elderly

目的探讨全关节镜下[⻊母]长屈肌腱转位治疗老年陈旧性跟腱断裂的效果。方法回顾性分析2017年1月至2020年12月于武汉市第四医院实施手术治疗的34例老年陈旧性跟腱断裂患者的临床资料,根据手术方式的不同分为观察组(实施全关节镜下[⻊母]长屈肌腱转位治疗,16例)与对照组(实施开放[⻊母]长屈肌腱转位治疗,18例),比较两组术后相关并发症发生情况,采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分及Arner-Lindholm评分优良率评价患者足踝部功能恢复情况及跟腱功能改善情况。结果所有患者均获随访,随访时间12~18个月,平均14个月。随访期间均未出现跟腱再断裂,疼痛以及提踵不能症状均较术前显著改善。治疗前,两组AOFAS评分差异无统计学意义(t=1.663,P=0.106);治疗后,观察组AOFAS评分高于对照组,差异有统计学意义(P=0.000)。治疗后12个月,观察组Arner-Lindholm评分优良率差异无统计学意义(P>0.05)。观察组并发症发生率低于对照组,差异有统计学意义(χ^(2)=14.789,P=0.005)。结论全关节镜下[⻊母]长屈肌腱转位治疗老年陈旧性跟腱断裂具有创伤小、手术并发症少、术后功能恢复快的优势,可获得较好的疗效。

Objective To explore the therapeutic effect of all-arthroscopic flexor hallucis longus tendon transfer in treating chronic achilles tendon ruptures in the elderly.Methods A retrospective analysis of clinical data from 34 elderly patients with chronic achilles tendon ruptures treated surgically from January 2017 to December 2020 from Wuhan No.4 Hospital was conducted.The patients were divided into two groups based on the surgical approach:the observation group(16 cases treated with all-arthroscopic flexor hallucis longus tendon transfer)and the control group(18 cases treated with open great toe flexor tendon transfer).Preoperative postoperative complications,AOFAS scores,and Arner-Lindholm method scores were compared to assess the functional recovery of the ankle and the improvement of achilles tendon function.Results All patients were followed up for 12 to 18 months,with an average of 14 months.During the follow-up period,there were no cases of achilles tendon re-rupture,and symptoms of pain and inability to heel raise were significantly improved compared to preoperative conditions.There was no significant difference in AOFAS scores between the two groups before treatment(t=1.663,P=0.106);After treatment,the observation group scored higher than the control group,with a statistically significant difference(P=0.000).there was no significant difference in the excellent-good rate of Arner-Lindholm method scores after 12 months of treatment(P>0.05);there was a significant difference in the incidence of surgical complications between the two groups(χ^(2)=14.789,P=0.005).Conclusion All-arthroscopic flexor hallucis longus tendon transfer for treating chronic achilles tendon ruptures in the elderly has the advantages of minimal trauma,low surgical complications,and rapid postoperative functional recovery,and can achieve favorable therapeutic effects.