改良Lindholm腓肠肌倒转腱膜瓣加强修复急性跟腱断裂

目的探讨治疗急性跟腱断裂的手术方法及疗效。方法对Lindholm腓肠肌倒转腱膜瓣加强修复跟腱断裂术进行改良,修复45例急性跟腱断裂。用Kessler法缝合跟腱断端,改良术中切取大小为0.5 cm×7cm 2条腓肠肌腱膜瓣,预制成腱膜片后倒转包裹修复跟腱缝合端,恢复外形。结果术后无感染、切口坏死、腓肠神经损伤及跟腱再断裂等并发症,跟腱修复处外形良好。患者均获随访,时间12～20个月。术后1年根据Arner-Lindholm评定标准评价治疗效果:优43例,良2例。结论改良Lindholm腓肠肌倒转腱膜瓣是加强修复急性跟腱断裂的有效手术方法。     

跖肌腱扇形膜片和腓肠肌腱瓣V—Y成形术治疗陈旧性跟腱断裂

目的 研究跖肌腱扇形膜片和腓肠肌腱瓣V—Y成形术治疗陈旧性跟腱断裂的术式及结果。方法 对14例平均89d陈旧性跟腱断裂患者采用跖肌腱扇形膜片和腓肠肌腱瓣V—Y成形术治疗，跟腱缺损范围为3．6～7．3cm．平均为5．2cm，跟腱缺损范围较大时(大于6．5cm)，可加用跖肌腱加固术。结果 平均随访2年4个月，按Arner-Lindholm疗效评定标准评估，优11例(78．6％)，良2例(14．3％)，优良率为93％。结 论跖肌腱扇形膜片和腓肠肌腱瓣V—Y成形术治疗陈旧性跟腱断裂，临床疗效满意，值得推广。     

V-Y肌腱瓣修复治疗Kuwade Ⅲ型陈旧性跟腱断裂的疗效观察

[目的]探讨V-Y肌腱瓣修复治疗KuwadeⅢ型陈旧性跟腱断裂的临床疗效。[方法]自2003年5月～2009年8月采用V-Y肌腱瓣修复治疗29例KuwadeⅢ型陈旧性跟腱断裂患者,男21例,女8例,年龄9～58岁,平均39.6岁。所有患者均采用跟腱止点外侧至小腿中部的略S形切口和V-Y肌腱瓣修复术治疗。[结果]术后获14～46个月(平均28个月)随访。无皮缘坏死、伤口感染和神经损伤并发症。按照Arner-Lindholm疗效评定标准,优25例,良4例,优良率为100%。患侧跟腱外形均与健侧一致。[结论]V-Y肌腱瓣修复术是一种有效的手术方法,适用于跟腱缺损3～6 cm时(即KuwadeⅢ型)陈旧性跟腱断裂的重建治疗,具有不增加局部体积、切口易愈合,跟腱外观恢复理想等优点。     

腓骨短肌转移治疗跟腱修复术后再断裂

[目的]总结以腓骨短肌转移治疗跟腱修复术后再断裂的手术方法和效果。[方法]本组患者共11例,男10例,女1例。年龄26～51岁,平均37.5岁。外院予行初次手术时均为新鲜闭合性断裂,所用术式包括腓肠肌腱瓣翻转缝合1例和直接端端缝合10例。初次修复术后因皮肤坏死、功能操练不当或再次受伤而发生再断裂。再断裂至再次手术的时间为1～3周。再次手术时均采用腓骨短肌转移修复跟腱;1例局部皮肤坏死者予以清创、跟腱修复并游离移植股前外侧皮瓣覆盖创面。术后6周依次采用长腿石膏前托、长腿管型石膏、短腿管型石膏固定;积极而循序渐进地进行功能操练。[结果]所有病例术后随访12～18个月,平均14个月。手术切口均顺利愈合,1例游离移植皮瓣完全存活。2例术后发生足部外侧感觉减退,术后2～3周恢复。所有患者均未发生跟腱的再次断裂及足内翻畸形。根据Arner/Lindholm跟腱修复疗效标准进行评定,优6例,良4例,差1例,优良率为90.9%。[结论]腓骨短肌移植可以填补跟腱缺损,同时保证修补部位的力学强度和愈合,从而利于术后功能操练的顺利进行,并且对踝关节的外翻功能不会造成明显损害,是治疗跟腱修复术后再断裂的良好选择。     

跖肌腱扇形膜片和腓肠肌腱瓣V-Y成形术治疗陈旧性跟腱断裂

目的　研究跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗陈旧性跟腱断裂的术式及结果。方法　对 14例平均 89d陈旧性跟腱断裂患者采用跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗 ,跟腱缺损范围为 3 6～ 7 3cm ,平均为 5 2cm ,跟腱缺损范围较大时 (大于 6 5cm) ,可加用跖肌腱加固术。结果　平均随访 2年 4个月 ,按Arner-Lindholm疗效评定标准评估 ,优 11例 (78 6 % ) ,良 2例 (14 3% ) ,优良率为 93%。结论　跖肌腱扇形膜片和腓肠肌腱瓣V -Y成形术治疗陈旧性跟腱断裂 ,临床疗效满意 ,值得推广。     

带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的疗效分析

目的 通过对应用带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的病例随访,以评价疗效.方法 于跟腱近端将位于深层的比目鱼肌腱与位于浅层的腓肠肌腱分开,并向近端分离,根据缺损范围预留肌腱长度,横向切断比目鱼肌腱纤维,形成带有肌蒂的肌腱瓣,向下牵拉延长,与跟腱远端缝接,肌腱瓣近端与腓肠肌腱缝接,缝合跟腱两侧,完成跟腱重建.治疗26例,获得随访18例.结果 18例获随访14～72个月,应用Termann跟腱损伤的临床评价标准进行评定:优13例,良4例,可1例,优良率达94.4%.其中开放性损伤1例术后皮肤发生部分坏死,经行皮瓣转移术后延期愈合;余17例伤口均Ⅰ期愈合.无感染发生及跟腱再次断裂.结论 带肌蒂比目鱼肌肌腱瓣延长重建跟腱术,具有损伤小、操作简便、功能康复好的优点,适用于缺损范围在7.5 cm以内的各种类型的闭合性跟腱缺损的修复重建.     

V-Y肌腱瓣修补术治疗陈旧性跟腱断裂

目的 研究V—Y肌腱瓣修补术治疗陈旧性跟腱断裂的手术方法及结果。方法 对9例平均112d的陈旧性跟腱断裂患，采用小腿三头肌V—Y肌腱瓣修补术治疗修补缺损为3．2～6cm，平均4．6cm。结果 平均随访2年8个月，按Arner-Lindholm疗效评定标准评估，优7例(77．8％)，良2例(22．2％)，优良率为100％。结论 对于陈旧性跟腱断裂，小腿三头肌V—Y肌腱瓣修补术足一种方法简单、疗效满意的手术方法。     

腓肠肌腱膜瓣翻转联合阔筋膜移植治疗跟腱再断裂

目的:探讨腓肠肌腱膜瓣翻转联合阔筋膜移植修复跟腱再断裂的临床疗效。方法 :自2013年7月至2017年4月,对11例跟腱术后再断裂患者采用腓肠肌腱膜瓣翻转联合阔筋膜移植重建治疗,男10例,女1例;年龄25～48岁。所有患者术前患足跖屈力量减弱、单足提踵试验阳性。观察术后并发症,并于术后6个月采用美国足踝外科学会踝-后足功能评分(AOFAS)进行功能评价。结果:本组11例患者获得随访,时间6～11个月。所有患者手术切口均Ⅰ期愈合,无皮肤坏死、切口感染、深静脉血栓、再断裂等并发症。跟腱缺损长度4～7 cm。患者完全恢复负重时间8～11周。术后6个月AOFAS评分79～100分,其中优9例,良2例。结论:腓肠肌腱膜翻转联合阔筋膜移植修复跟腱再断裂,具有跟腱修复可靠,并发症少,跟腱功能恢复良好的优点,是一种有效的临床治疗方法。     

Lindholm法治疗陈旧性跟腱断裂的疗效分析

目的评价Lindholm法治疗陈旧性跟腱断裂的疗效。方法对17例陈旧性跟腱断裂患者行Lindholm法手术治疗修复重建跟腱连续性,术后石膏外固定6周,之后进行康复训练。结果17例均获得随访,时间8～24个月,根据Amer-Lindholm评分标准进行疗效评价：优12例,良4例,差1例。结论Lindholm法治疗陈旧性跟腱断裂,结合术后合理的康复功能锻炼,功能恢复满意,疗效可靠。     

带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的疗效分析

目的 通过对应用带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的病例随访,以评价疗效.方法 于跟腱近端将位于深层的比目鱼肌腱与位于浅层的腓肠肌腱分开,并向近端分离,根据缺损范围预留肌腱长度,横向切断比目鱼肌腱纤维,形成带有肌蒂的肌腱瓣,向下牵拉延长,与跟腱远端缝接,肌腱瓣近端与腓肠肌腱缝接,缝合跟腱两侧,完成跟腱重建.治疗26例,获得随访18例.结果 18例获随访14～72个月,应用Termann跟腱损伤的临床评价标准进行评定:优13例,良4例,可1例,优良率达94.4%.其中开放性损伤1例术后皮肤发生部分坏死,经行皮瓣转移术后延期愈合;余17例伤口均Ⅰ期愈合.无感染发生及跟腱再次断裂.结论 带肌蒂比目鱼肌肌腱瓣延长重建跟腱术,具有损伤小、操作简便、功能康复好的优点,适用于缺损范围在7.5 cm以内的各种类型的闭合性跟腱缺损的修复重建.     

Active tendon implants in flexor tendon reconstruction

Forty-five active flexor tendon implants were evaluated after placement in scarred tendon beds of digits II through V. The implant is constructed of silicone rubber with a Dacron core, terminating in a loop proximally and a metal plate distally. Modification of the implant during the period of study has improved its reliability and longevity. The improvement in total active motion (TAM) averaged 72 degrees during implant functioning (stage I) in a group of digits that before operation were classified as 78% Boyes grade 5 (salvage). Complication rate during stage I was 11% (5 out of 45). Of the 27 digits evaluated after implant replacement by tendon autograft (stage II), there was an overall improvement in 62 degrees total active motion with 70% of digits being Boyes grade 5. Many of the complications were believed to be avoidable with experience. This study demonstrates the feasibility of an active tendon implant and the possibility of a permanent prosthesis.     

Experimental tendon grafting within intact tendon sheath

A chicken toe experimental model was used to study the fate of flexor tendon grafts, introduced into intact tendon sheaths. After perfusion of the limb by India Ink, the vascular pattern of the graft and the synovial sheath could be identified. The grafts showed no or few adhesions to the sheath. With time, there was a conversion from a diffuse superficial vascular pattern towards a concentration of vessels on the dorsal aspect of the graft. In a control group, where the sheath had been resected, adhesions were more apparent, and could be observed still after 16 weeks. These results are in complete agreement with previous experimental findings and further confirm the importance of an intact tube system in the digit.     

手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究

目的比较手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植结果并对异体滑膜肌腱在鞘管区的移植进行评估.方法对在手指屈肌腱鞘区内应用异体滑膜肌腱与自体非滑滑膜肌腱移植的病例,术后进行3个月以上的随访.评定标准为关节活动范围（TAM法）、力量,及二期肌腱松解率.结果异体滑膜肌腱移植280例,优良率达57.0%,较差或差为11.0%.松解率为32.0%,松解后总优良率达93.0%.自体非滑膜肌腱移植98例,优良率达43.0%,较差或差为9.0%.松解率为49.0%,松解后总优良率达94.2%.两者的最终结果无明显差异.结论肌腱表面结构影响肌腱的营养途径及肌腱愈合质量,滑膜肌腱表面结构则有益于肌腱营养与较快建立起血循环及组织液的渗透,是减少肌腱术后粘连再次松解的主要因素.     

Adenovirus-mediated gene transfer into tendon and tendon sheath

In this study, we successfully transferred the Escherichia coli β-galactosidase gene, LacZ, into the chicken tendon and tendon sheath by a recombinant adenovirus. The recombinant adenovirus Adv-βgal that carried the E. coli LacZ gene was constructed by homologous recombination in 293 cells (human transformed embryonic kidney) between the expressing vector and the ClaI large fragment of adenovirus 5 genome. Each chicken received a 10 μl injection, containing 10⁵ plaque-forming units of recombinant virus Adv-βgal, into the tendon sheath of the long toe. Samples of tendon and tendon sheath were harvested at 3, 30, and 75 days after the injection. The LacZ gene transfer was detected for its coding product β-galactosidase by staining with X-gal solution. The results showed that all tendon and tendon sheath samples from the three harvest times stained positive (blue). The tendon sheath samples were more extensively stained; staining of the tendon was limited to the epitenon layer. These data suggest that a functional exogenous gene can potentially be transferred into the tendon and tendon sheath by similar techniques; such techniques may be used to improve healing and reduce adhesion formation.