病例报告—一例儿科患者创伤性跟腱断裂漏诊管理

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详细

背景。文献对儿童创伤性跟腱断裂漏诊鲜有报道。成人患者跟腱断裂漏诊延迟重建的多种技术已有描述，但对生长期儿童来说，此类技术的长期结果尚不可知。

临床病例。本文对一名跟腱断裂漏诊8岁女童患者进行了临床观察，患儿在创伤7周后，在跖肌腱加强基础上行Kessler端端吻合术。术后两年随访，患儿完全无症状。

讨论。通过查阅文献表明，这是第3例儿童创伤性跟腱断裂漏诊。第一例是一名10岁男童，创伤6周后，通过开放手术以Bunnell缝合法成功修复。第二例是一名7岁女童，创伤8周后行跖肌腱加强Bunnell端端缝合术。

结论。采用跖肌腱加强肌腱修复能取得满意临床效果和最小发病率。预后取决于决定长期功能恢复结果的跟腱损伤程度。腿后部皮肤损伤需进行系统仔细检查，以确定是否伤及跟腱。

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作者简介

Saad Andaloussi

Marche Verte Hospital, Regional Delegation of Public Health Boulemane

编辑信件的主要联系方式.
Email: andaloussi.saad@yahoo.com
ORCID iD: 0000-0002-5382-1481

MD, pediatric surgeon

摩洛哥, Avenue Annakhil, Missour 33250

参考

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补充文件

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2. 图 1 临床检查：a，与对侧相比，患者患侧踝关节背屈增加（箭头所示）；b，位于跟腱中部约4厘米的愈合皮肤伤口； c，出现肉眼可见和可触及的跟腱压迫，提示跟腱局部缺损

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3. 图 2 手术干预阶段：a，在跟腱断裂中心位置，作后内侧皮肤切口；b，跟腱断缘收缩后，两跟腱断端间隙约为3厘米； c，摘取跖肌腱，保留远端插入；d，以跖肌腱加强行跟腱重建术的术中最终效果

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4. 图 3 术后两年：a，患侧跖屈强度恢复到未损伤足水平；b，患儿能够提踵；c，未发现皮肤并发症

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