应用腓肠肌逆转筋膜瓣移植结合缝合锚固定治疗陈旧性跟腱断裂

目的 探讨应用腓肠肌逆转筋膜瓣移植缝合锚加强固定治疗陈旧性跟腱断裂的长期疗效。方法 自2007年9月至2010年2月，应用腓肠肌逆转筋膜瓣移植缝合锚加强固定治疗陈旧性跟腱断裂患者20例，其中男13例，女7例；年龄23～50岁，平均36岁；均为单侧损伤。肌腱缺损5～225px，平均167.5px。术后使用小腿支具制动，早期功能锻炼。随访患者，应用Arner-Lindhohm评分以及Leppilahti评分评估疗效。结果 患者术后顺利康复，无切口感染等并发症发生。20例患者均获得随访，平均38个月，末次随访时患者均可以患侧足趾踮脚站立。与健侧相比，患侧小腿肌肉力量恢复至89%。根据Arner-Lindhohm评分，患侧踝关节功能恢复优10例，良10例。Leppilahti评分平均得分为85分（60~100分），优9例，良10例，可1例。结论 应用腓肠肌逆转筋膜瓣重建跟腱并以缝合锚加强固定治疗陈旧性跟腱断裂，固定强度高，术后患者可早期功能锻炼，可有效避免肌腱粘连，功能恢复良好。

【关键词】 跟腱；移植，自体；腓肠肌逆转筋膜瓣

AN Weijun,ZHU Tao,LIU Haitao,MA Teng,GUO Wei wei. Department of traumatic orthopedics, The General Hospital of Ningxia Medical University, Yinchuan 75004, China

Reconstruction of chronic Achilles tendon rupture reconstructed with the use of gastrocnemius fascial turn-down flap and suture anchor

[Abstract] Objective: To explore the long-term results of the reconstruction of chronic Achilles tendon with the use of gastrocnemius fascial turn-down flap and suture anchor. Method From September 2007 to February 2010, twenty patients with unilateral chronic Achilles tendon was reconstructed with gastrocnemius fascial turn-down flap, strengthened using suture anchor. There were thirteen male and seven female with an average age of 36 years (range, from 23 to 50). The defect gap was 167.5px on average (range, from 5 to 225px). The brace was used to immobilize the lower limber, and early exercise was encouraged. The patients were followed up, and Arner-Lindhohm scoring system and Leppilahti scoring system was applied to assess the clinical outcomes. Result The postoperative course was uneventful. No patient experienced deep infection or wound problems. Eighteen patients were followed up for a mean of 38 months. At the latest follow up, all patients can stand on the injured toes. The strength of the affected lower limber was restored to 89% of the unaffected side. According to Arner-Lindhohm score, ten patients were rated as excellent and ten as good. The average Leppilahti score was 85 (range, from 60 to 100) with nine excellent, ten good and one fair results. Conclusion The chronic Achilles tendon rupture can be reconstructed using the gastrocnemius fascial turn-down flap and strengthened by suture anchor. The patients can start early exercise postoperatively, avoiding adhesion of tendon, with good to excellent functional recoveries of the injured ankles.

[Keywords] Achilles tendon; Transplantation; autolouous;Gastrocnemius fascial turn-down flap