Noninsertional Achilles Tendinopathy Treated with Gastrocnemius Lengthening
Noninsertional Achilles Tendinopathy Treated with Gastrocnemius Lengthening
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DOI：
10.3113/fai.2011.0375
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发表时间：
2011-04-01
影响因子：
2.7
通讯作者：
Assal, Mathieu
中科院分区：
文献类型：
--
作者：
Duthon, Victoria B.;Luebbeke, Anne;Assal, Mathieu
背景：手术通常被视为治疗难治性、有症状的非止点性跟腱病的一种选择。腓肠肌马蹄足会导致跟腱机械性过载，可能是其病因中的一个因素。我们的假设是，通过腓肠肌延长（斯特雷耶手术）减少跟腱的负荷传递可能是一种有效的治疗方法。
材料与方法：对所有患有至少1年有症状的非止点性跟腱病并接受腓肠肌延长术的患者进行前瞻性病例系列研究，在术前以及术后1年和2年进行评估。共有14名患者（17条肌腱）。
结果：术后1年，美国足踝外科协会（AOFAS）踝 - 后足评分中位数为100分，而术前为71分（p < 0.001）。足部功能指数（FFI）总分中位数在1年时从39分显著下降至12分（p < 0.001），并在2年时保持稳定（12分）。电子测角仪记录到踝关节背屈平均增加13度。术后1年，术前进行磁共振成像（MRI）的所有8名患者（10条肌腱）的MRI显示信号高强度和肌腱大小均减小，这表明跟腱病有所改善。术后2年，患者满意度评估显示，除1名患者外，所有患者对结果满意，14名患者中有11名（79%）能够恢复以前的体育活动。无并发症发生。
结论：腓肠肌延长术是治疗慢性跟腱非止点性跟腱病的一种有效方法。2年的结果显示临床效果良好至优秀。
Background: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment. Materials and Methods: A prospective case series of all patients with a minimum 1-year symptomatic noninsertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons). Results: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively (p < 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year (p < 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications. Conclusion: Gastrocnemius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome.