拇长屈肌腱转位结合挤压螺钉重建KuwadaⅣ型陈旧性跟腱断裂

摘要

Objective:To explore the clinical effect of interference screw and flexor hallucis longus tendon as augmenta⁃tion material in repair of chronic Achilles tendon rupture. Methods:From September 2010 to June 2012,26 patients with chronic Achilles tendon rupture were treated,including 18 males and 8 females with an average age of 44.2 years old(20 to 66 years old). All patients were unilateral damage. MRI showed the Achilles tendon ends' distance was 6.0 to 9.0 cm. The postoperative complications were observed. The curative effect was assessed by American Orthopedic Foot and Ankle Society and Leppilahti score. Results:All the 26 patients were followed up for 18 to 68 months(means 30.4 months). No neurological injury and infection of incision occurred,all patients were stage I incision healing. The shape and function of the ankle were re⁃covered well. The average AOFAS score increased from 52.27±12.30 preoperatively to 90.92±6.36 postoperatively. Leppilahti Achilles Tendon Repair score increased from 34.23 ± 12.86 preoperatively to 90.00 ± 5.10 postoperatively. Conclusion:The flexor hallucis tendon transfer with an interference screw technique for repairing the chronic Achilles tendon rupture of type IV of Kuwada had advantages of simple operation,quick recovery,firm tendon fixation,and less complications.%目的：探讨拇长屈肌腱转位后应用挤压螺钉重建陈旧性KuwadaⅣ型跟腱断裂的临床效果。方法：回顾性分析2010年9月至2012年6月，拇长屈肌腱转位后采用挤压螺钉固定重建26例陈旧性跟腱断裂患者的临床资料，其中男18例，女8例；年龄20～66岁，平均44.2岁。所有患者为单侧损伤。MRI显示跟腱断端距离为6.0～9.0 cm。观察术后并发症情况，并采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足评分及Leppilahti跟腱修复评分进行评价疗效。结果：26例获得随访，时间18～68个月，平均30.4个月。术后无神经损伤及切口感染，所有患者切口Ⅰ期愈合。术后踝关节外形及功能恢复良好，AOFAS踝与后足评分由术前52.27±12.30提高至术后90.92±6.36（t=-18.26，P<0.05）。Leppilahti跟腱修复评分术前34.23±12.86提高至术后90.00±5.10分（t=-22.67， P<0.05）。结论：拇长屈肌腱转位后应用挤压螺钉固定来重建陈旧性KuwadaⅣ型跟腱断裂具有操作简单，术后恢复快、肌腱固定牢靠、并发症少的优点。