踇长屈肌.ppt

踇长屈肌踇长屈肌PurposeThe purpose of this study was to report the management and outcome of 11 patients presenting with chronic Achilles tendon(AT)rupture treated by a modified flexor hallucis longus(FHL)transfer.Patients A series of 11 patients(seven men,four women)treated by a modified FHL transfer for chronic AT rupture by a single surgeon The average age of patients at surgery was 44 years(range,2770).The average body mass index(BMI)was 25.8 (range,2138).The average pre-operative American Orthopedic Foot and Ankle Society(AOFAS)score was 64(range,5880)Operative Technique Debridement of tendon was performed with conservation of a distal and a proximal fibrous flap.The average AT defect after debridement was 7.4 cm(range,2.510).After incision of the deep fascia of the leg the FHL were identified and isolated.To harvest the distal portion of the FHL,a second short medial arch incision was performed.The FDL tendons were identified and connections between FHL and FDL were freed.FHL tendon was sectioned distally at the Henrys knot and was pulled out using the posterior approach.transverse 4.5-mm drill tunnel was made in the posterior calcaneal cortex.The FHL tendon was pulled through the tunnel.Next,the FHL tendon was tenodesed to itself with a tension fixed at 40 of plantar flexion.Augmentation with suture of two remaining Achilles fibrous flaps and fixation on FHL transfer was made.ResultsThe average follow-up of the series was 79 months(range,4881).No major complications or concerns with regards to wound healing were noted.The average time to work and sports recovery was five months(range,212)and ten months(range,618),respectively.However,all patients returned to a sports activity at a lower level compared to pre-injury level.No re-rupture has been recorded at latest follow-up.Mean pre-operative AOFAS score improved from 64 points to 98 points(range,90100)at latest follow-up(p5 cm.VY延长，联合肌腱移植Kuwadas classificationType-I lesion 部分断裂石膏固定 Type-II lesion 完全断裂，缺损小于3cm端端吻合Type-III lesion 完全断裂，缺损大于3cm，小于6cm肌腱移植，可联合合成材料加强Type-IV lesion 完全断裂，缺损大于6cm腓肠肌翻瓣及肌腱移植和/或合成材料加强踇长屈肌腱作为重建移植物踇长屈肌腱(flexor hallucis longus,FHL)既能用于修复短节段也能用于长节段的跟腱缺损，在所有跟腱周围可转位肌腱中该肌腱对踝关节影响最小，因此常作为跟腱周围肌腱移植重建跟腱的首选。踇长屈肌腱取材方法：单切口 腱腹联合至跟骨载距突双切口 腱腹联合至Henry 角远端小切口腱腹联合至第一趾间关节单切口 腱腹联合至跟骨载距突5.08cm双切口 腱腹联合至Henry 角6.72cm远端小切口腱腹联合至第一趾间关节17.49cm踇长屈肌腱与趾长屈肌腱联合腱移植物切口方法单切口 腱腹联合至跟骨载距突5.08cm双切口 腱腹联合至Henry 角6.72cm远端小切口腱腹联合至第一趾间关节17.49cm移植物固定方法跟骨结节横行骨道横穿远端跟腱组织Endobutton 固定踇长屈肌腱优点：足拇长屈肌腱作为移植腱有足够的长度以双束重建后与原跟腱直径相似 肌腹较低血运佳 因其与足屈肌腱、小腿三头肌同属胫后神经支配，为协同肌，转位后对踝关节稳定影响小 足拇长屈肌腱缺点：移植后足拇指屈趾动作力弱，力量损失29%（13-30%）。在滑冰、体操、舞蹈运动项目影响比较大。日常生活无明显影响。如拇屈长肌腱远断端与趾长屈肌腱适当张力下吻合，可加强术后屈拇力量。术后效果作者作者例例数数平均平均年龄年龄随访随访年限年限AOFAS力量损失力量损失SF-36 scores 取材方式取材方式固定方式固定方式Martin RL 4458.23.491.630%ns趾间关节骨道Julien W11446.69828%30 deg/sec 36%120 deg/sec Henrys 骨道加压螺钉Tian Jing 2139.51.593.5-Henrys Endobutton Rahm S 241852566.13.0898525%23%66%77Henrys 经肌腱骨道Elias I 15421.994.122.3%60 deg/sec 13.5%120 deg/sec 单切口Miao X 22481.593.0趾间关节骨道加压螺钉Walther M 2561389单切口骨道加压螺钉我们的结果