下肢缺血性肌孪缩的功能重建.pdfVIP

下肢缺血性肌孪缩的功能重建 唐昊 张少成 张秋林 马辉 朱宏伟 【摘要】目的：探讨下肢缺血性肌孪缩的功能重建及提出分型方 法。方法：对 42 例下肢缺血性肌孪缩患者根据情况分别行肌肉神经 的松解、跟腱和拇长屈肌腱延长、跟腱条交叉移位屈拇长肌腱、足内 在肌松解、骨间肌剥离、腓肠神经吻接胫神经术等。结果：术后所有 患者平路行走无明显影响，10 例患者术后足下垂得到改善，5 例患者 上下楼梯或上下坡路时略感困难，对 12 例取部分跟腱交叉移位屈拇 长肌的患者解决了大拇指抓地无力的症状，增加了行走的稳定性。7 例取患侧腓肠神经吻接胫神经的患者，术后 2 例感觉可达到 S2，5 例可达到 S3。结论：缺血性孪缩是下肢损伤后较为严重的并发症， 严重影响患者的功能和生活质量，预防孪缩的发生远重于治疗其本 身。笔者首创采用的跟腱条交叉移位屈拇长肌腱和腓肠神经连接胫神 经，可改善患者的一部分功能，为重度小腿缺血性孪缩的功能重建提 供了一个可供选择的办法。 【关键词】缺血性肌孪缩 分型 功能重建 Fuctional reconstruction of ischemic contracture in the lower limb Tang Hao, Zhang Shao-cheng, Zhang Qiu-lin, et al. Department of orthopaedics, Changhai Hospital, Shanghai 200433, China Corresponding author: Zhang Shao-cheng, E-mail: shczhang2003@ Abstract: Objective: To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose an ischemic contracture classification system in the lower limb based on the severity and prognosis. Methods: A total of 42 patients with ischemic contracture in the lower limb were included in this study. According to the differen type and severity of the contracture, reconstruction surgery such as nerve decompression, tendon lengthening or transfers, intrinsic foot muscles 作者单位：200433 上海，第二军医大学附属上海长海医院骨科( 唐昊、张少成、张秋林、马辉) 通讯作者：张少成，E-mail:shczhang2003@ release and sural-tibial nerve anastomosis were performed in every patient. Results: Postoperatively, all patients were able to walking on flat ground. Drop foot was corrrected in 10 patients, and five among them still feel some difficulty during dowonstair and upstair. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and the walking stability was improv