踇长屈肌.ppt

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 例数 平均年龄 随访年限 AOFAS 力量损失 SF-36 scores 取材方式 固定方式 Martin RL 44 58.2 3.4 91.6 30% ns 趾间关节 骨道 Julien W 11 44 6.6 98 28%@30 deg/sec 36%@120 deg/sec － Henry’s 骨道加压螺钉 Tian Jing 21 39.5 1.5 93.5 - -- Henry’s Endobutton Rahm S 24 18 52 56 6.1 3.0 89 85 25% 23% 66% 77％ Henry’s 经肌腱 骨道 Elias I 15 42 1.9 94.1 22.3%@60 deg/sec 13.5%@120 deg/sec －－ 单切口 －－ Miao X 22 48 1.5 93.0 －－ －－ 趾间关节 骨道加压螺钉 Walther M 25 61 3 89 －－ －－ 单切口 骨道加压螺钉 我们的结果 * proximal * k?lke?n??l k?:teks * Calcaneus k?lke?n?rs * [h?l?ks] fe?l?nd???l * Purpose The 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, 27–70). The average body mass index (BMI) was 25.8 (range, 21–38). The average pre-operative American Orthopedic Foot and Ankle Society (AOFAS) score was 64 (range, 58–80) 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, 2.5–10). 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 Henry’s knot and was pulled out using the posterio