| Objective: To draw the corresponding preventive measures and the reasonable operation scheme by analyzed the nosogenesis,the clinical manifesttation,the treatment method and the operation scheme selection of Old Achilles tendon rupture(OATR),in order to guide the clinical,improve the level of diagnosis and treatment.Achilles tendon rupture is a common Motor system damage,it often occurs in young adults,and is the most commom limb tendon tear.Achilles tendon rupture often misdiagnosis,misdiagnosis or delayed diagnosis because of people’s lack of knowledge.The characteristics of the blood supply of Achilles tendon and surrounding skin is easy to cause wound infection,the defection or necrosis of the skin.In appropriate functional exercise after operation is easy to cause another fracture of Achilles tendon.It is difficult to repair Achilles tendon and seriously affects the function of the ankle joint and Achilles tendon in these factors.So this is a very tricky problem of trauma surgery in the treatment of OATR and the repairment of wound.This subject include 32 cases retrospectively analyzed the pathogenic factors,and the function of ankle joint and Achilles tendon of different operation mode,in order to improve the level of operation scheme selection of OATR,and we can provide better service to patients.Method: The choice of Achilles tendon rupture in thirty-two patients,a total of thirty-two cases,male twenty cases,female twenteen cases,forteen cases on the left side,right side in eighteen cases,age three years old to sixty-five years old,average 39.4 years old,was injured to the hospital three hours to two years etc.Of which:Achilles tendon rupture delayed diagnosis and misdiagnosis in twenteen cases,seven cases of spontaneous rupture of Achilles tendon,two-times after surgery or infection in eight cases,five cases of two stage operation after Achilles tendon rupture.The choice of operation method according to the Achilles tendon defect length of fracture time,local skin condition and operation:seven cases in which the use of end-to-end suture,gastrocnemius tendon flap repair flip extension in sixteen cases,anchor repair in nine cases,five cases of sural neurocutaneous flap for repair of skin defect,one cases of allograft tendon transplantation Achilles tendon rupture range is less than 50%,no repair was performed in one case.Repair of Achilles tendon after oppplication of gypsum or external fixator fixed.The patients were followed up,the follow-up time of three months to six years,using the Termann scoring system for Achilles tendon injury evaluation criteria,including ankle flexion angle,calf circum ference,standing on his one foot,the old ruputer strength,thompson extrusion experiment,physical activity,pain,subjective strength,sensitivity to weather,treatment satisfaction eleven content,out of 100 points,excellent 90-100 grading,good 80-89,Results: In thirty-two patients,one patient lost contact,one case died,the other thirty cases were followed up,the return rate of 93.8%.In the thirty cases got followed up patients,twenteen cases accepted the interview,eneiteen cases received follow-uo telephone interview,in twenteen cases of patients in addition to completing the follow-up sheet,but also for medical examination,examination content of motion and maximum plantar flexion angleand back extension, calf circumference,incision near the skin feeling situation,standing with single foot heel raise situation.The overall result is:excellent in eighteen cases(60%),good in seven cases(23.3%),three cases(10%),poor in two cases(6.67%),the excellent and good rate was 83.3%.Conclusion:1 OATR causes mainly include:acute Achilles tendon rupture misseddiagnosis,misdiagnosisand delayed diagnosis;the Achilles tendon itself lesions;the Achilles tendon blood circulation and its characteristics;the operation is standardize;the selection of treatment is not appropaiate,operation time holdinaccurate.2 Gastrocnemius tendon lengthening flip flap can provide enough lengthof the tendon flap, larger rupture of Achilles tendon defect repair, the small trauma, faster healing, post operative function of ankle joint position fixing, prevent tendon adhesion, ankle joint stiffness and other complications after operation.3 Gastrocnemius tendon lengthening combined with flip flap sural neurovascular flap can one stage repair of oldachilles tendon rupture associated with local skin defect, to avoid the trauma and complications of operation twotimes,is beneficial to the recovery of the function of patients, but also reduce the economic burden of patients, is worthy of clinical promotion... |
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