关节镜下跟腱延长术在儿童马蹄足中的应用

发布时间：2018-07-07 21:36

本文选题：微创 + 关节镜　；参考：《中国矫形外科杂志》2017年03期

【摘要】：[目的]探索关节镜下解剖性跟腱延长微创治疗儿童马蹄足的手术方法。[方法]对2013年1月-2014年1月收治的儿童马蹄足患儿12例16足,采用跟腱中段小切口关节镜入路,镜下经皮依次切断跟腱比目鱼肌肌腱跟骨止点部分和腓肠肌肌腱近端,背伸患足,使之达背伸20°~30°。自关节镜中段切口处以可吸收缝合器缝合已松解的跟腱,背伸位石膏固定6周。6周后负重功能锻炼。术后随访测量患足背伸角度,并行AOFAS踝-后足评分。[结果]所有病例平均随访12.6个月,足背伸较术前有明显改善,踝关节活动范围平均术前背伸(5.9±4.7)°,术后背伸(24.8±3.1)°,术前与术后比较差异有统计学意义(P0.01),术后与随访时比较差异无统计学意义(P0.05)。关节镜组与非关节镜组术后6个月随访时患足背伸活动度及AOFAS评分对比,关节镜下组较传统长切口组有优势;AOFAS踝-后足评分比较,与经皮跟腱延长术未见明显差异。关节镜下跟腱延长未见严重并发症,行走功能明显改善,跟腱固定处无不适,患足背伸肌力良好。[结论]关节镜下跟腱延长术,可镜下观察跟腱解剖分型,根据不同分型,实施确切跟腱延长松解,充分松解跖肌腱,切口小,创伤小,并发症少,操作安全,疗效满意。
[Abstract]:Objective: to explore the operative method of arthroscopic anatomical extension of Achilles tendon in the treatment of horseshoe foot in children. [methods] from January 2013 to January 2014, 12 cases (16 feet) of horseshoe foot were treated by arthroscopic approach with small incision of Achilles tendon. The calcaneal end of Achilles tendon soleus tendon and proximal end of gastrocnemius tendon were severed successively under the microscope. To extend the foot 20 掳to 30 掳. The decomposed Achilles tendon was sutured with an absorbable suture from the middle incision of arthroscope, and the weight bearing function was exercised after 6 weeks of plaster fixation in extensor position. The angle of dorsal extension of affected foot and AOFAS ankle-hind foot score were measured after operation. [results] all patients were followed up for an average of 12.6 months. The average range of ankle extension was (5.9 卤4.7) 掳before operation and (24.8 卤3.1) 掳after operation. There was significant difference between preoperative and postoperative (P0.01), but there was no significant difference between postoperative and follow-up (P0.05). There was no significant difference between arthroscopic group and non-arthroscopic group in terms of AOFAS ankle-hind foot score compared with traditional long incision group, and there was no significant difference between arthroscopic group and non-arthroscopic group in terms of extension of dorsalis pedis and AOFAS score after 6 months follow-up, and no significant difference was found between arthroscopy group and percutaneous Achilles tendon lengthening operation. Arthroscopic lengthening of Achilles tendon had no serious complications, walking function was obviously improved, no discomfort was found in the fixation of Achilles tendon, and the extensor muscle of dorsalis pedis was good. [conclusion] Anatomical classification of Achilles tendon can be observed under arthroscopy. According to different types, exact extension of Achilles tendon and full release of plantar tendon are performed, incision is small, trauma is small, complication is less, operation is safe and curative effect is satisfactory.
【作者单位】：青岛市妇女儿童医院小儿骨科;
【分类号】：R726.8

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