腓骨骨瓣转移固定术治疗复发性腓骨肌腱脱位的中长期疗效
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摘要
目的:观察腓骨骨瓣转移固定术治疗复发性腓骨肌腱脱位的中长期疗效。方法:对1994年11月～2008年12月北京大学第三医院运动医学研究所手术治疗的31例复发性腓骨肌腱脱位的病例进行随访,所有病例均采用腓骨骨瓣转移固定术,分别应用主观评价、美国足踝外科学会(AOFAS)踝-后足评分系统、Mazur踝关节评分系统和满意度进行疗效评定。结果:失访4例,27例得到随访,随访时间9.4±4.2年(5～17年)。1例术后恢复良好,但在术后第5年一次运动时再次意外脱位,二次手术治疗后未再脱位,余26例至今未发生脱位。术后随访时两种评分均显著提高,AOFAS术前70.3±7.9分,术后随访时95.3±5.2分(t=18.99,P<0.001);Mazur评分术前67.4±11.0,术后随访时94.9±4.6分(t=17.04,P<0.001)。患者满意度优良率达92.6%(25/27)。结论:腓骨骨瓣转移固定术治疗复发性腓骨肌腱脱位操作简单,损伤小,中长期疗效满意。
ObjectiveTo evaluate the medium-and long-term effect of the fibular bone flap trans-fer treating the recurrent dislocation of the peroneal tendon.MethodsThirty-one patients receiving sur-gical treatment for recurrent dislocation of the peroneal tendon between November 1994 and December2008 in the Institute of Sports Medicine,Peking University Third Hospital were followed up. All pa-tients underwent the fibular bone flap transfer and were assessed using the subjective assessment,theAmerican orthopedic foot and ankle society scoring system(AOFAS),Mazur ankle score and patient sat-isfaction scale.ResultsTwenty-seven patients were followed up for 9.4 ± 4.2(range,5-17) years ex-cept four cases dropping out. Among them, 26 had not experienced any dislocation. Dislocation oc-curred in one case at the 5 th year,but no dislocation reoccurred after a second surgery. The averageAOFAS and Mazur score improved significantly from 70.3 ± 7.9 to 95.3 ± 5.2 and 67.4 ± 11.0 to94.9 ± 4.6 before and after the surgery(t=18.99, P<0.001; t=17.04, P<0.001). Twenty-five patients(92.6%) were satisfied with the surgery.ConclusionsThe fibular bone flap transfer treating the recur-rent dislocation of the peroneal tendon is simple but with little injury,as well as satisfactory medium-and long-term effects.
ObjectiveTo evaluate the medium-and long-term effect of the fibular bone flap trans-fer treating the recurrent dislocation of the peroneal tendon.MethodsThirty-one patients receiving sur-gical treatment for recurrent dislocation of the peroneal tendon between November 1994 and December2008 in the Institute of Sports Medicine,Peking University Third Hospital were followed up. All pa-tients underwent the fibular bone flap transfer and were assessed using the subjective assessment,theAmerican orthopedic foot and ankle society scoring system(AOFAS),Mazur ankle score and patient sat-isfaction scale.ResultsTwenty-seven patients were followed up for 9.4 ± 4.2(range,5-17) years ex-cept four cases dropping out. Among them, 26 had not experienced any dislocation. Dislocation oc-curred in one case at the 5 th year,but no dislocation reoccurred after a second surgery. The averageAOFAS and Mazur score improved significantly from 70.3 ± 7.9 to 95.3 ± 5.2 and 67.4 ± 11.0 to94.9 ± 4.6 before and after the surgery(t=18.99, P<0.001; t=17.04, P<0.001). Twenty-five patients(92.6%) were satisfied with the surgery.ConclusionsThe fibular bone flap transfer treating the recur-rent dislocation of the peroneal tendon is simple but with little injury,as well as satisfactory medium-and long-term effects.
引文
[1] Heckman DS, Reddy S, Pedowitz D, et al. Operativetreatment for peroneal tendon disorders. J Bone JointSurg Am,2008,90:404-418.
[2] Dombek MF, Lamm BM, Saltrick K, et al. Peronealtendon tears:a retrospective review. J Foot AnkleSurg,2003,42:250-258.
[3]肖健,胡跃林,敖英芳,等.创伤性腓骨肌腱脱位18例回顾性分析[J].中国运动医学杂志,2004,23(5):543-545.
[4] Park HJ,Cha SD,Kim HS,et al. Reliability of MRI?-ndings of peroneal tendinopathy in patients with lateralchronic ankle instability. Clin Orthop Surg, 2010, 2:237-243.
[5] Ferran NA, Oliva F, Maffulli N. Recurrent subluxationof the peroneal tendons. Sports Med, 2006, 36:839-846.
[6] Kitaoka HB,Alexander LI,Adelaar RS,et al.Clinical rating systems for the ankle—hindfoot,midfoot,hallux,andlesser toes.Foot Ankle Int,1994,15;349-393.
[7] Meguire MR,Kyle RF,Gustilo RB,et al. Comparativeanalysis of ankle arthroplasty versus ankle arthodesis.Clin Orthop Related Research,1988,226:174-181.
[8] Oliva F,Del Frate D,Ferran NA,et al. Peroneal tendons subluxation. Sports Med Arthrosc,2009,17:105-111.
[9] Heckman DS, Gluck GS, Parekh SG. Tendon disordersof the foot and ankle,part 1:peroneal tendon disorders.Am J Sports Med,2009,37:614-625.
[10] Sammarco VJ,Sammarco GJ. Injuries to the tibialis anterior,peroneal tendons,and long?exors of the toes. In:Porter DA, Schon LC, eds. The Foot and Ankle inSport,Philadelphia:Elsevier,2007:121-146.
[11] Clement H,Grechenig W,Peicha G,et al. Ultrasounddiagnosis in knee and foot trauma. Orthopade, 2002,31:332-335.
[12] Neustadter J, Raikin SM, Nazarian LN. Dynamic sonographic evaluation of peroneal tendon subluxation. AJRAm J Roentgenol,2004,183:958-985.
[13] Church CC. Radiographic diagnosis of acute peroneal tendon dislocation. AJR Am J Roentgenol, 1977, 129:1065-1068.
[14] Sammarco VJ. Peroneal tendoscopy:indications and techniques. Sports Med Arthrosc,2009,17:94-99.
[15] Scholten PE, van Dijk CN. Tendoscopy of the peronealtendons. Foot Ankle Clin,2006,11:415-420.
[16] Van Dijk CN,Kort N. Tendoscopy of the peroneal tendons. Arthroscopy,1998,14:471-478.
[17] McLennan JG. Treatment of acute and chronic luxationsof the peroneal tendons. Am J Sports Med, 1980, 8:432-436.
[18] Stover CN,Bryan D. Traumatic dislocation of the peroneal tendons. Am J Surg,1962,103:180-186.
[19] Cho J, Kim JY, Song DG, et al. Comparison of outcome after retinaculum repair with and without fibulargroove deepening for recurrent dislocation of the peroneal tendons[J].Foot Ankle Int,2014,35(7):683-689.
[20] Miyamoto W,Takao M,Miki S,et al.Tendoscopic repair of the superior peroneal retinaculum via 2 portalsfor peroneal tendon instability[J].Foot Ankle Int,2015,36(10):1243-1250.
[21] Smith SE, Camasta CA, Cass AD. A simpli?ed technique for repair of recurrent peroneal tendon subluxation. J Foot Ankle Surg,2009,48:277-280.
[22] Viernstein K,Rosemeyer B. A method of operative treatment of recurrent displacement of peroneal tendons.Arch Orthop Unfallchir,1972,74:175-181.
[23] Boykin RE,Ogunseinde B,McFeely ED,et al. Preliminary results of calcaneo?bular ligament transfer for recurrent peroneal subluxation in children and adolescents. JPediatr Orthop,2010,30:899-903.
[24] Ferran NA, Maffulli N, Oliva F. Management of recurrent subluxation of the peroneal tendons. Foot AnkleClin,2006,11:465-474.
[25] Ogawa BK,Thordarson DB. Current concepts review:peroneal tendon subluxation and dislocation. Foot AnkleInt,2007,28:1034-1040.
[26] Mendicino RW,Orsini RC,Whitman SE,et al. Fibulargroove deepening for recurrent peroneal subluxation. JFoot Ankle Surg,2001,40:252-263.
[27] Walther M, Morrison R, Mayer B. Retromalleolargroove impaction for the treatment of unstable peronealtendons. Am J Sports Med,2009,37:191-194.
[28] Scholten PE, Breugem SJ, van Dijk CN. Tendoscopictreatment of recurrent peroneal tendon dislocation. KneeSurg Sports Traumatol Arthrosc, 2013, 21(6):1304-1306.
[29] van Dijk PA,Gianakos AL,Kerkhoffs GM,et al. Return to sports and clinical outcomes in patients treatedfor peroneal tendon dislocation:a systematic review[J].Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1155-1164
[30] Maqdes A, Steltzlen C, Pujol N. Endoscopic fibulargroove deepening for stabilisation of recurrent peronealtendons instability in a patient with open physes[J].Knee Surg Sports Traumatol Arthrosc, 2017, 25(6):1925-1928.
[2] Dombek MF, Lamm BM, Saltrick K, et al. Peronealtendon tears:a retrospective review. J Foot AnkleSurg,2003,42:250-258.
[3]肖健,胡跃林,敖英芳,等.创伤性腓骨肌腱脱位18例回顾性分析[J].中国运动医学杂志,2004,23(5):543-545.
[4] Park HJ,Cha SD,Kim HS,et al. Reliability of MRI?-ndings of peroneal tendinopathy in patients with lateralchronic ankle instability. Clin Orthop Surg, 2010, 2:237-243.
[5] Ferran NA, Oliva F, Maffulli N. Recurrent subluxationof the peroneal tendons. Sports Med, 2006, 36:839-846.
[6] Kitaoka HB,Alexander LI,Adelaar RS,et al.Clinical rating systems for the ankle—hindfoot,midfoot,hallux,andlesser toes.Foot Ankle Int,1994,15;349-393.
[7] Meguire MR,Kyle RF,Gustilo RB,et al. Comparativeanalysis of ankle arthroplasty versus ankle arthodesis.Clin Orthop Related Research,1988,226:174-181.
[8] Oliva F,Del Frate D,Ferran NA,et al. Peroneal tendons subluxation. Sports Med Arthrosc,2009,17:105-111.
[9] Heckman DS, Gluck GS, Parekh SG. Tendon disordersof the foot and ankle,part 1:peroneal tendon disorders.Am J Sports Med,2009,37:614-625.
[10] Sammarco VJ,Sammarco GJ. Injuries to the tibialis anterior,peroneal tendons,and long?exors of the toes. In:Porter DA, Schon LC, eds. The Foot and Ankle inSport,Philadelphia:Elsevier,2007:121-146.
[11] Clement H,Grechenig W,Peicha G,et al. Ultrasounddiagnosis in knee and foot trauma. Orthopade, 2002,31:332-335.
[12] Neustadter J, Raikin SM, Nazarian LN. Dynamic sonographic evaluation of peroneal tendon subluxation. AJRAm J Roentgenol,2004,183:958-985.
[13] Church CC. Radiographic diagnosis of acute peroneal tendon dislocation. AJR Am J Roentgenol, 1977, 129:1065-1068.
[14] Sammarco VJ. Peroneal tendoscopy:indications and techniques. Sports Med Arthrosc,2009,17:94-99.
[15] Scholten PE, van Dijk CN. Tendoscopy of the peronealtendons. Foot Ankle Clin,2006,11:415-420.
[16] Van Dijk CN,Kort N. Tendoscopy of the peroneal tendons. Arthroscopy,1998,14:471-478.
[17] McLennan JG. Treatment of acute and chronic luxationsof the peroneal tendons. Am J Sports Med, 1980, 8:432-436.
[18] Stover CN,Bryan D. Traumatic dislocation of the peroneal tendons. Am J Surg,1962,103:180-186.
[19] Cho J, Kim JY, Song DG, et al. Comparison of outcome after retinaculum repair with and without fibulargroove deepening for recurrent dislocation of the peroneal tendons[J].Foot Ankle Int,2014,35(7):683-689.
[20] Miyamoto W,Takao M,Miki S,et al.Tendoscopic repair of the superior peroneal retinaculum via 2 portalsfor peroneal tendon instability[J].Foot Ankle Int,2015,36(10):1243-1250.
[21] Smith SE, Camasta CA, Cass AD. A simpli?ed technique for repair of recurrent peroneal tendon subluxation. J Foot Ankle Surg,2009,48:277-280.
[22] Viernstein K,Rosemeyer B. A method of operative treatment of recurrent displacement of peroneal tendons.Arch Orthop Unfallchir,1972,74:175-181.
[23] Boykin RE,Ogunseinde B,McFeely ED,et al. Preliminary results of calcaneo?bular ligament transfer for recurrent peroneal subluxation in children and adolescents. JPediatr Orthop,2010,30:899-903.
[24] Ferran NA, Maffulli N, Oliva F. Management of recurrent subluxation of the peroneal tendons. Foot AnkleClin,2006,11:465-474.
[25] Ogawa BK,Thordarson DB. Current concepts review:peroneal tendon subluxation and dislocation. Foot AnkleInt,2007,28:1034-1040.
[26] Mendicino RW,Orsini RC,Whitman SE,et al. Fibulargroove deepening for recurrent peroneal subluxation. JFoot Ankle Surg,2001,40:252-263.
[27] Walther M, Morrison R, Mayer B. Retromalleolargroove impaction for the treatment of unstable peronealtendons. Am J Sports Med,2009,37:191-194.
[28] Scholten PE, Breugem SJ, van Dijk CN. Tendoscopictreatment of recurrent peroneal tendon dislocation. KneeSurg Sports Traumatol Arthrosc, 2013, 21(6):1304-1306.
[29] van Dijk PA,Gianakos AL,Kerkhoffs GM,et al. Return to sports and clinical outcomes in patients treatedfor peroneal tendon dislocation:a systematic review[J].Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1155-1164
[30] Maqdes A, Steltzlen C, Pujol N. Endoscopic fibulargroove deepening for stabilisation of recurrent peronealtendons instability in a patient with open physes[J].Knee Surg Sports Traumatol Arthrosc, 2017, 25(6):1925-1928.