腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损

作者自行设计使用腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损４８例，获得完整随访资料４３例。跟腱缺损长度为８－１０ｃｍ，自身已无修复条件。手术方法的优点：联合转移的肌腱弥补了长距离跟腱缺损，保持了原有肌肉的动力，弥补了小腿三头肌的挛缩无力。     

腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损

作者自行设计使用腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损48例,获得完整随访资料43例。跟腱缺损长度为8～10cm,自身已无修复条件。手术方法的优点:联合转移的肌腱弥补了长距离跟腱缺损,保持了原有肌肉的动力,弥补了小腿三头肌的挛缩无力。保持了足内、外翻的肌力平衡,足外形正常。肌肉的血循环不受干扰,增加了修复跟腱后愈合的机会。手术后6周都能逐渐下地行走,肌力一般都能达到Ⅳ级～V级,功能恢复良好,未发生因愈合不良再次发生断裂。     

腓骨长肌前侧半修复跟腱断裂体会

目的探讨腓骨长肌前侧半修复跟腱断裂的疗效。方法采用腓骨长肌前侧半修复16例不同类型跟腱断裂,术后短腿石膏固定患肢,4周后拆除石膏行功能锻炼。按照Arner-Lindholm标准评价临床治疗结果。结果手术切口5～8 cm,手术时间30～70 min,术中出血约20～50 mL。手术后切口甲级愈合14例,乙级愈合2例。住院时间3～14 d,随访18～24个月,均未出现跟腱再断裂。按Arner-Lindholm评定标准,优良率93.7%(15/16),踝关节功能恢复正常。结论腓骨长肌前侧半修复跟腱断裂,方法简便,效果满意,是一种值得推荐的治疗选择。     

腓骨长肌腱移位修复闭合性跟腱断裂

目的探讨腓骨长肌腱移位修复闭合性跟腱断裂的应用解剖、生物力学和手术方法。方法在50侧动脉灌注红色乳胶的成人下肢标本上,观察腓骨长肌腱形态及血液供应,并进行肌腱拉伸破坏实验。设计腓骨长肌腱移位重建跟腱的术式,2001年3月~2004年7月临床应用10例闭合性跟腱断裂的患者,其中男7例,女3例;年龄32~54岁。跳跃伤6例,砸伤2例,踏空伤及自发伤各1例。新鲜伤7例,受伤至手术时间6h~7d;陈旧伤3例,受伤至手术时间21d~3个月。其中完全性断裂8例,不完全性断裂2例。结果腓骨长肌起于胫骨近端及腓骨头,止于第1跖骨基底及骰骨内侧表面,肌腱长13.5±2.5cm;起始部宽0.9±0.2cm,厚0.3±0.1cm;外踝尖平面宽0.7±0.1cm,厚0.4±0.1cm;骰骨头平面宽0.7±0.1cm,厚0.3±0.1cm。有多个血供来源。肌腱拉伸破坏实验示最大拉力:跟腱、腓骨长肌腱、腓骨短肌腱及胫骨后肌腱分别为2292.4±617.3、1020.4±175.4、752.0±165.4及938.2±216.7N。临床应用10例术后切口均期愈合;获随访18~24个月,无再断裂发生,无皮肤坏死等手术并发症。按照AmerLind-holm评定标准优7例,良3例,跟腱功能恢复良好。结论对于闭合性跟腱断裂,腓骨长肌腱移位修复跟腱是一种方法简便,疗效满意的手术方法。     

跟腱术后再断裂的相关因素分析

目的探讨影响跟腱术后再断裂的相关因素。方法对1996年9月至2007年9月间收治的275例跟腱断裂手术患者（再断裂18例）进行回顾性分析。对随访资料运用SPSS12.0软件进行统计学分析,即对其性别、年龄、手术质量、术后外固定时间、术后负重时间、术后锻炼强度、感染、糖尿病、使用激素、抽烟、延迟治疗、断裂前是否存在跟腱炎等因素进行多因素分析,来判断造成跟腱再断裂的相关因素。结果 275例患者获得平均6个月（3～10个月）随访,手术后再断裂18例（占6.5%）,再断裂发生时间为术后3～13周,平均5.5周。由感染、术后锻炼强度、术后外固定时间、延迟治疗、术后负重时间、断裂前是否存在跟腱炎这6组因素对跟腱术后再断裂的综合作用最大。结论预防感染、正确的术后处理、及时的治疗和术前对患者的自身疾病的正确评估能最大程度减少跟腱断裂术后再断裂的发生。     

腓骨长肌转位修复陈旧性跟腱断裂

陈旧性跟腱断裂手术修复较困难，术后效果与新鲜断裂相比较差，且重建的跟腱由于瘢痕增生而粗大，踝关节活动受限。作者于2000年8月-2003年11月利用腓骨长肌转位重建跟腱术19例，取得满意效果。     

腓骨长肌转位修复陈旧性跟腱断裂

作者报告２１例采用自行设计的腓骨长肌转位修复陈旧性跟腱断裂。本手术与传统的Ｂｏｓｗｏｒｔｈ氏法Ｌｉｎｄｈｏｌｍ氏法和Ａｂｒａｈａｍ氏ＶＹ＂腱成形术相比手术简单易行。术后跟腱多无粗大的瘢痕粘连，踝关节活动较好。随访６个月～１０年，优：１１例，良：６例，可：４例。随访结果表明，本手术是一种较好的修复陈旧性跟腱断裂的方法之一。     

腓骨长肌腱转移术治疗陈旧性跟腱断裂

[目的]探讨利用腓骨长肌腱治疗陈旧性跟腱断裂的手术方法和经验. [方法]将腓骨长肌腱在远端处切断,经皮下隧道移位修复跟腱断裂. [结果]根据Arner-Lindholm评定标准,优11例,良10例.未发生跟腱再次断裂.2例出现伤口延迟愈合,经康复训练,所有患者均在术后10周左右弃拐完全负重行走. [结论]用腓骨长肌腱治疗断端缺损较多,或者肌腱在跟骨结节附近断裂的陈旧性跟腱断裂是一种疗效满意,康复较快的手术方法.     

腓骨长肌腱移位修复陈旧性跟腱断裂16例体会

跟腱断裂在小腿和足部肌腱损伤中较常见,陈旧性跟腱断裂手术修复较困难。笔者于2001年2月~2007年7月,利用腓骨长肌腱移位重建跟腱术治疗陈旧性跟腱断裂16例,取得满意效果。1临床资料1.1一般资料本组16例,男14例,女2例;年龄16~48岁。左侧4例,右侧12例;闭合性损伤15例,开放性1例;     

腓骨长肌转位修复阵旧性跟腱断裂

作者报告２１例采用自行设计的腓骨长肌转位修复阵旧性跟腱断裂。本手术与传播的Ｂｏｓｗｏｒｔｈ氏法Ｌｉｎｄｈｏｌｍ氏法和Ａｂｒａｈａｍ氏“Ｖ－Ｙ”腱成形术相比手术简单易行。术后跟腱多无粗大的瘢痕粘连，踝关节活动较好。本手 术是一种较好的修复阵旧性跟腱断裂的方法之一。     

Peroneus brevis plasty in large achilles tendon defects

Surgical Principles Bridging of large Achilles tendon defects with the proximally pedicled tendon of the peroneus brevis muscle. Reinforcement of the transfer with the plantaris tendon, or part of the tendon of the peroneus longus muscle. (The technique was first used by W. Blauth in 1968. Subsequent literature reviews revealed that White and Kraynick, as well as Trillat et al., published a similar technique as early as 1959 and 1967 [3, 4]). Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 14–21 (German Edition).     

Persistent disability despite sufficient calf muscle strength after rerupture of surgically treated acute achilles tendon ruptures

Rerupture after treatment of acute Achilles tendon rupture is considered a serious complication. Yet data on long-term outcome after rerupture are limited. This study evaluated outcome after rerupture and compares it to a reference of uncomplicated cases. Thirteen patients with a rerupture following minimally invasive surgical Achilles tendon rupture repair were evaluated using Leppilahti score and resumption of work and sport. Mean follow-up was 8.7 years. Results were compared with a reference group of 23 uncomplicated cases with a follow-up of at least 1 year. The study was designed as a follow-up study. The relative risk for a fair/poor outcome by Leppilahti score after a rerupture when compared with uncomplicated cases is 2.83 (95% confidence interval=1.17-6.87; P=.0185). Although rerupture did not affect ultimate resumption of professional life, the relative risk for quitting sport or resuming sport at a lower level after a rerupture is 3.33 (95% confidence interval=1.71-6.51; P=.0001). In contrast, the plantar flexion strength deficit is 5% to 10% in the rerupture group and up to 20% in the reference group. Despite sufficient recovery of calf muscle strength, rerupture after acute Achilles tendon rupture treatment results in significant long-term functional disabilities.     

吻合膝降血管大收肌腱游离移植复跟腱缺损

目的 报道吻合膝降血管大收肌腱移植修复跟腱缺损新的方法及临床效果。方法 在４２侧下肢标本解剖观测了大收肌腱形态和血供来源、血管走行、分支和分布情况，设计了吻合膝降血管的大收肌腱游离移植修复跟腱缺损的术式。结果 临床应用８例，全部病例随访２～８个月，临床近期效果满意。结论 吻合管大收肌腱游离移植修复跟腱缺损具有术式简单，再造跟腱外形近似正常，受区损伤小等优点，是跟腱缺损修复一个良好的供区。     

小切口与常规切口端端吻合治疗新鲜跟腱断裂的疗效比较

目的 比较小切口与常规切口端端缝合治疗新鲜跟腱断裂的疗效.方法 2006年3月至2009年6月分别采用常规切口和小切口治疗93例新鲜跟腱断裂患者,其中常规切口组(A组)52例,男47例,女5例;年龄23～62岁,平均44.2岁.小切口组(B组)41例,男38例,女3例;年龄22～65岁,平均42.6岁.术后应用相同的康复程序,采用临床客观检查、患者主观满意率及美国足踝外科协会(AOFAS)评分进行评价.结果 A组患者术后获15 ～52个月(平均28个月)随访,B组患者术后获13～50个月(平均26个月)随访.A组切口表浅感染6例,深部感染l例,感染率为13.5％,B组均未发生切口感染等并发症;A组平均切口长度较B组长7.3 cm;A组平均AOFAS评分为93分,B组为98分,以上指标两组比较差异均有统计学意义(P＜0.05).跟腱与皮肤切口粘连发生率、再断裂率、踝关节活动受限发生率、患者满意率、小腿最大周径伤侧与对侧的差、跟腱断裂平面周径伤侧与对侧的差及恢复伤前活动时间两组比较差异均无统计学意义(P＞0.05).两组患者均未产生因腓肠神经损伤导致的足背皮肤感觉障碍,无小腿深静脉血栓形成.除l例发生深部感染,其他患者均恢复伤前活动.结论 应用跟腱缝合引导器及小切口微创修复新鲜腱断裂总体结果优于常规切口技术.     

Ankle stabilization and primary repair with a peroneus brevis tendon graft

Nineteen of the author's 20 patients recovered fully from a ruptured anterior talofibular ligament when it was repaired or replaced by a tendon graft from one-half of the peroneus brevis tendon. The patients wore a below-the-knee weight-bearing cast for 3 to 4 weeks after the surgery and none of the patients had residual instability.     

Sonographic differentiation of digital tendon rupture from adhesive scarring after primary surgical repair

PURPOSE: After the surgical repair of finger tendons finger range of motion may be limited by tendon rupture or adhesive scarring. Differentiating tendon rupture from adhesive scarring may be difficult clinically. Digital tendon sonography allows the evaluation of tendon integrity in a dynamic setting. Our objective was to determine if sonography could differentiate tendon rupture from adhesive scarring in patients who have had primary tendon repair. METHODS: A retrospective review was performed of the radiographic, clinical, and surgical records of patients referred for finger sonography over a 2-year period. Twenty-eight digits in 21 patients were evaluated for finger tendon disruption after primary surgical repair. The diagnosis of complete tendon rupture was made when 1 or more of the following was identified: a gap separating the proximal and distal tendon margins, visualization of only the proximal tendon margin, or visualization of only the distal tendon margin. Adhesive scarring was diagnosed if the tendon appeared intact with abnormal peritendinous soft tissue abutting or partially encasing the tendon, with synovial sheath thickening, or with restricted tendon motion during dynamic evaluation. RESULTS: Sonography correctly identified tendon rupture or adhesive scarring in 27 of 28 digits with 1 false-positive case (sensitivity, 100%; specificity, 93%; positive-predictive value, 93%; negative-predictive value, 100%; accuracy, 96%). CONCLUSIONS: Sonography is an accurate modality for differentiating tendon rupture from adhesive scarring in patients with prior surgical tendon repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic, Level I.     

Evaluation of Achilles tendon rerupture

The authors found that after either surgical or conservative treatment ankle dorsiflexion played a significant role in patients with reruptures and also in those who did not rerupture. They believe that patients who are either casted or treated by surgical repair with their foot in equinus may have a greater chance of rerupture.     

The assessment of flexor tendon function after primary tendon repair

Because the actual methods of assessment and the grading of these methods in favor at any one time have changed so much over the last 50 years, the usefulness of the considerable experience in this field for practitioners today is much reduced. Agreement on the systems of assessment to be used for the different parts of the flexor system would allow a better exchange of knowledge worldwide at this time and a more useful cumulative experience for the next 50 years. If an acceptable method of assessment of any particular injury and its treatment can be agreed on by all, two stages remain for us to audit our work. The first is identifying how much we must downgrade the expectations of the assessment to accommodate the imperfections of our treatments. Most patients would consider an "excellent" result to be a return to normal. Currently, using, for example, the first Strickland system of assessment, we are happy to call any result of primary repair of a zone 2 flexor tendon division greater than 85% of normal, "excellent." How much we should reasonably downgrade our assessments is a variable that one hopes would reduce with accumulated experience, but one that makes repeated adjustment of our methods of assessment essential. Having set the level of the "excellent," "good," "fair," and "poor" qualifying bands relative to normal digital function, it only remains to take our measuring instruments out of their boxes and measure!