背景:孤立的腓肠肌挛缩与30多种下肢疾病有关,包括足底足跟痛/足底筋膜炎,跟腱病,马尾,成年扁平足,和meta骨痛。虽然许多技术可用于腓肠肌衰退,潜在的麻醉剂,化妆品,和伤口相关的并发症会导致患者不满。开放式和内镜下收缩技术通常需要硬膜外麻醉或全身麻醉,下肢放血和缝合,并可能损害腓肠神经,在手术的所有阶段都不受外科医生的完全控制。这项研究的目的是评估用针延长腓肠肌的手术技术的临床效果,如先前在尸体标本中所述。
结果:我们在24例(19例)腓肠肌挛缩症患者中使用针头进行了超声引导下腓肠肌肌腱延长II级的前瞻性研究。研究人群包括12名男性和7名女性。平均年龄为41岁(18-64岁)。除5次衰退外,所有衰退都是双边的,并且同时发生。该手术的适应症是腓肠肌挛缩;尽管患者还出现了其他情况,例如6例患者(2例为双侧)的非插入性跟腱病,插入式跟腱钙化附件炎4例(1例为双侧),跖骨痛4例,柔性扁平足1例,足底筋膜炎5例(双侧2例)。纳入标准是先前保守方案的失败,西尔夫斯基德测试是阳性的,并且患者所遭受的病理符合手术延长患者的适应症,并在科学文献中有所描述。排除标准是不符合纳入标准,和有手术风险的患者ASA3或以上和儿童。在这些患者中,虽然可能,最好在手术室进行监控,以及儿童,因为他们在办公室的手术过程中可能会感到不安。我们使用Abbocath针的倾斜尖端作为手术刀。所有患者都经历了腓肠肌肌腱的衰退,就像在一个不完整的Strayer版本中一样。我们评估了术前和术后背屈,结果,和程序疼痛(基于视觉模拟量表和美国骨科足踝协会评分),以及潜在的并发症。没有损坏sural束。
结果:踝关节背屈平均增加17.89°。术前术后疼痛视觉模拟评分平均为5.78,术后第一周为5.53,1.89在1个月,3个月时为0.26,在9个月时减少到0.11。术后美国骨科足踝协会踝关节平均评分术前平均为50.52,1周时43.42,72.37在1个月,3个月时87.37,9个月时为90.79。
结论:超声引导下针延长腓肠肌肌腱是一种新颖的,安全,和有效的技术,使外科医生能够清楚地检查所有的结构,从而将神经血管损伤的风险降至最低。结果令人鼓舞,这种方法的优点包括没有伤口,不需要缝合。恢复快速且相对无痛。超声引导针延长腓肠肌肌腱的一个特殊的优点是,它可以在专家办公室进行,用一个非常基本的仪器和局部麻醉,从而减少开支。
BACKGROUND: Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens.
RESULTS: We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18-64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.
RESULTS: Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.
CONCLUSIONS: Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist\'s office, with a very basic instrument set and local anesthesia, thus reducing expenses.