小儿脑瘫的跟腱延长成形术和原始腱鞘成形术

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论证。小儿脑瘫患者的胫三头肌缩短会导致协调和步态障碍，造成一系列矫形后遗症，降低生活质量，使患者的康复变得复杂。有许多手术方法可以矫正挛缩，恢复踝关节的活动。治疗效果并不总是令人满意。并发症的数量仍然很高，主要是肌腱切开术后畸形复发和肌腱缝合失败。

本研究的目的是分析在小儿脑瘫后遗症患者中使用原始肌腱缝合技术进行小腿肌腱延长成形术的结果，并通过临床实例回顾该手术技术的特殊性。

材料和方法。文章介绍了我们在4例小儿脑瘫后遗症患者中应用的原肌腱缝合技术的跟腱延长成形术。本文介绍了对一名30岁左胫骨三头肌痉挛性瘫痪患者进行手术治疗的临床观察结果。对术后1至12个月的治疗效果进行了追踪。对主动和被动关节运动的幅度、肌肉张力、术后并发症的存在和性质以及功能结果进行了评估。

结果。术后一年，2例最初较严重病例的效果被认为良好，2例观察结果被评为优秀。所有患者的疼痛程度都有所减轻，活动量得到恢复，胫骨三头肌的张力过高和萎缩程度减轻，并且没有出现并发症。

结论。根据所获得的数据，我们可以认为小腿肌腱延长术对胫三头肌痉挛性瘫痪患者的病理治疗是有效的。所建议的手术治疗新方法提供了肌腱末端的正确解剖并列和紧密接触，可以降低腓肠肌-肱骨复合体的张力，保持关节的生理性活动度，及早开始康复，降低复发的可能性。

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作者简介

Andrey M. Guryanov

Orenburg State Medical University

Email: guryanna@yandex.ru
ORCID iD: 0000-0002-8085-3307
SPIN 代码: 6684-7052

MD, PhD, Cand. Sci. (Med.), Assistant Professor

俄罗斯联邦, Orenburg

Vladimir I. Studenov

Orenburg State Medical University; Orenburg Regional Clinical Hospital n.a. V.I. Voynov

Email: dapkap2015@yandex.ru
ORCID iD: 0000-0002-0891-3651

MD, orthopedic and trauma surgeon

俄罗斯联邦, Orenburg; Orenburg

Andrey A. Averyanov

Orenburg State Medical University; Orenburg Regional Clinical Hospital n.a. V.I. Voynov

Email: averyanov.ortoped@yandex.ru
ORCID iD: 0000-0003-2739-8605

MD, PhD, Cand. Sci. (Med.), Honored Doctor of the Russian Federation

俄罗斯联邦, Orenburg; Orenburg

Timur V. Bykov

Orenburg State Medical University; Orenburg Regional Clinical Hospital n.a. V.I. Voynov

Email: acromion014@gmail.com
ORCID iD: 0000-0002-2575-404X

MD, orthopedic and trauma surgeon

俄罗斯联邦, Orenburg; Orenburg

Andrey P. Klimov

Orenburg State Medical University

Email: aclimov@mail.ru
ORCID iD: 0009-0005-4006-5444

MD, orthopedic and trauma surgeon

俄罗斯联邦, Orenburg

Mariya A. Guryanova

Orenburg State Medical University

编辑信件的主要联系方式.
Email: mary.guryanova2018@yandex.ru
ORCID iD: 0009-0000-1306-5047

5th year student

俄罗斯联邦, Orenburg

参考

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2. Fig. 1. Patient A., 30 years old. Maximum possible active dorsiflexion of the foot before surgery

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3. Fig. 2. Patient A., 30 years old. Surgical approach. Oblique tenotomy and removal of the equinus of the foot

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4. Fig. 3. Patient A., 30 years old. Intraoperative result of Achilles tendon plastic repair and the original tenorrhaphy technique

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5. Fig. 4. Patient A., 30 years old. Surgical treatment results after 12 months: restoration of active dorsiflexion of the foot (a) and range of active flexion in the ankle joint (b)

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6. Fig. 5. Patient A., 30 years old. Surgical treatment results after 12 months. Restoration of the support ability of the left foot

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7. Fig. 6. Traditional suturing methods: a, Bunnell–Cuneo; b, Rozova–Kessler–Tajima; c, Tsuge; d, original suture

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