摘要
目的 :探讨陈旧性跟踺断裂的手术治疗和康复指导。方法 :对 3 8例陈旧性跟腱断裂患者 (其中误诊 2 0例 ,手术失败 18例 )分别采用V—Y缩短、水平重叠缩短、“Z”缩短、冠状纵劈缩短等成型 ,并在此基础上应用腓肠肌腱瓣翻转或跖肌腱转移加固术。术后按A—B—C—D—E顺序进行功能练习 ,同时辅以中药熏洗康复治疗。平均随坊 4.3年 ,按Arner -Lindholm疗效标准进行评定。结果 :优 2 8例 ,良 7例、差 3例 ,优良率为 92 .1%。结论 :陈旧性跟腱断裂多为运动伤 ,容易误 (漏 )诊。手术方法主要应用各种缩短成型 +腱瓣加固术 ,同时采用带蒂筋膜包裹跟腱吻合处 ,以增加局部血液循环 ,促进愈合 ,并减少与皮肤的粘连。术后中药熏洗并按照A—B—C—D—E顺序进行功能练习是提高治疗效果防止再断裂的关键。
Objective:To investigate the surgical treatment and rehabilitation of the old fragmentation of calcaneal tendon.Method:Thirty-eight patients suffered from old fragmentation of calcaneal tendon (included 20 cases with misdiagnosis and 18 cases with operative failure)were performed the plasty such as V-Y decurtation horizontal overlapping decurtation,“Z”decurtation and crown-shape longitudinel cutting decurtation combining with the subvolution of the tendon flap of gastrocenmlus muscle flap or the reinforcement with the shift of tendon of planter muscle.After operation the patients did the functional exercises by the order of A—B—C—D—E,and treated with the fuming-washing of Chinese herbs for rehabilitation.All patients were followed up for the average of 4.3 years.The clinical efficacy was evaluated by the Arner-Lindholm standard.Result:Twenty-eight cases gained the excellent results,7 cases of good and 3 cases bad,and the percentage of the cases with the excellent or good result was 92.1%.Conclusion: The old fragmentation of calcaneal tendon is caused mostly by the sports and can be easily misdiagnozed or fail to diagnoze,the surgical measures are mainly all kinds of decurtation plasty and the reinforcement with the tendon flap,meanwhile the anastomoslc tendon is wrapped with the pedicle fascia to increase the local flood perfusion,to improve the healing,and to reduce the adhension with skin.The functional exercises by the order of A—B—C—D—E and the fuming-washing with Chinese herbs are tile key to increase the effects of management and to prevent re-fragmentation.
出处
《中国矫形外科杂志》
CAS
CSCD
2004年第12期913-915,共3页
Orthopedic Journal of China
关键词
跟腱断裂
手术
康复
指导
Fragmentation of calcaneal tendon
Operation
Rehabilitation
Guide
