痉挛性马蹄内翻足的交通隧道腱-骨附着胫后肌转移术△

Cross-tunnel tendon-bone reattachment of tibialis posterior tendon transfer for correction for spastic clubfoot

摘要:

［目的］介绍隧道交通腱-骨锚定肌腱转移技术及其对痉挛性马蹄内翻足的初步临床结果。［方法］对 20 例痉挛性马蹄内翻足患者，行选择性胫神经肌支切断，并将胫后肌转移到骰骨或第三楔骨。在骨上制作相互交通的一个中央隧道和三个周围隧道，引入缝线并与肌腱末端缝合，将肌腱缝合固定在中央隧道内，缝合线末端在周围隧道外两两打结固定。术后随访半年，评定肌腱与骨愈合情况，踝关节屈伸活动度范围，Holden 步行能力和 6 min 距离。［结果］ 胫后肌转移后愈合率为 100%。 所有患者马蹄内翻畸形均消失，行走功能明显改善。与术前相比，术后 6 个月小腿三头肌肌张力 MAS 评分、踝关节屈伸活动范围 （range of motion, ROM），6 min 步行距离和 Holden 步行能力评分均显著改善 （P<0.05）。［结论］ 此隧道交通腱-骨固定胫后肌转移方法安全可靠，可有效矫正患肢马蹄内翻畸形，改善下肢负重行走功能。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of cross-tunnel tendon-bone reattach- ment of tibialis posterior tendon transfer for spastic clubfoot. [Methods] A total of 20 patients received cross-tunnel tendon-bone reattach- ment of tibialis posterior tendon transferred to cuboid or third cuneiform after selective peripheral neurotomy (SPN) for spastic foot equin- ovarus. A central tunnel and three surrounding tunnels were made to communicate with each other on the bone. As sutures were introduced into the tunnels and stitched with the tendon, the tendon was reattached into the central tunnel. The ends of sutures were knotted and se- cured in pairs outside the surrounding tunnels. The tendon and bone healing, ankle flexion-extension range of motion (ROM) , Holden scale of walking ability and 6-minute walking distance were assessed during follow-up period lasted for 6 months. [Results] The solid tendonbone healing of posterior tibialis transfer achieved in all patients with healing rate of 100%. The varus deformity was completely corrected, whereas walking function improved significantly in all patients. Compared with those before surgery, the triceps muscle tension MAS score, ROM, 6-min walking distance and Holden scale of walking capacity significantly improved at 6 months after surgery (P＜0.05) . [Conclusion] This cross-tunnel tendon-bone reattachment for tibialis posterior tendon transfer is a safe and reliable technique to correct varus equi- nus deformity, and improve the weight-bearing walking function of lower limbs.