摘要目的 评价应用深低温处理同种异体肌腱治疗KuwadeⅢ、Ⅳ型陈旧性跟腱断裂的临床疗效。方法 分析2015年5月至2019年2月湖北民族大学附属民大医院行手术治疗的67例KuwadeⅢ、Ⅳ型陈旧性跟腱断裂患者资料，其中男37例，女30例；年龄19~59岁，平均(35.2±10.5)岁。33例(A组)采用腓肠肌“V-Y”延长+腓肠肌腱膜瓣翻转跟腱重建治疗；34例(B组)采用经深低温处理同种异体肌腱移植治疗。比较两组术后并发症情况、患者术后恢复日常活动时间、末次随访时的患侧踝关节活动度；依据美国足踝外科协会(American society of foot and ankle surgery，AOFAS)踝-后足评分标准评估患侧踝关节功能；依据Arner-lindholm评分标准评估疗效。结果 67例患者术后获得12~16个月随访，平均随访时间(13.9±1.4)个月。术后A组切口感染1例，跟腱黏连1例；B组腓肠神经损伤1例，皮缘坏死1例；两组均未发生跟腱再断裂、深部感染、下肢深静脉血栓(deep vein thrombosis，DVT)等并发症。A组患者术后恢复活动时间(16.2±2.6)周，B组为(12.9±2.4)周，A组术后恢复活动时间晚于B组，差异有统计学意义(P＜0.05)。末次随访结果，A组患侧踝关节最大跖屈角(33.4±1.7)°、最大背伸角(16.2±1.1)°，B组患侧踝关节最大跖屈角(34.6±2.3)°、最大背伸角(15.7±1.2)°，两组比较差异均无统计学意义(P＞0.05)；A组AOFAS踝后足评分为(90.4±6.7)分，B组为(91.3±7.6)分，两组比较差异无统计学意义(P＞0.05)；A组Arner-lindholm评定优良率为81.8%，B组为97.1%，A组优良率低于B组，差异有统计学意义(P＜0.05)。结论 应用深低温处理同种异体肌腱治疗Kuwade Ⅲ、Ⅳ型陈旧性跟腱断裂，患者术后可较早恢复日常活动，并发症少，是一种可行的手术方法。
Abstract：Objective To evaluate the effects of cryopreserved allogeneic tendon for Kuwade type Ⅲ，Ⅳ chronic achilles tendon rupture.Methods From May 2015 to February 2019，67 patients with Kuwade type Ⅲ，Ⅳ chronic achilles tendon rupture were admitted and divided into group A，B.Among them，37 were males and 30 were females.They were 19 to 59 years old，with an average of (35.2±10.5)years old.The 33 patients of group A were treated with gastrocnemius V-Y tendon flap extension and tendon flap graft reconstructed.And the 34 cases of group B were treated with cryopreserved allogeneic tendon graf reconstructed. The postoperative complications，the time to resume daily activities after the operation and the range of motion of the affected ankle joint at the last follow-up were compared between the two groups.At the last follow-up，the function of the affected ankle joint were evaluated according to the AOFAS ankle-hindfoot scoring standard.The efficacy were evaluated according to the Arner-lindholm scoring standard.Results 67 patients were followed up for 12 to 16 months with an average of(13.9±1.4)months.Postoperatively，there was 1 case of incision infection and 1 case of achilles tendon adhesion in group A.There were 1 case of sural nerve injury and 1 case of skin necrosis in group B.However，no achilles tendon re-rupture，deep infection and DVT occurred in both groups.The recovery time was(16.2±2.6)weeks in group A and (12.9±2.4)weeks in group.Group A was later than the group B，and the difference was statistically significant(P＜0.05).At the last follow-up，the maximum plantar flexion and dorsal extension angle of the affected ankle was(33.4±1.7)° and was(16.2±1.1)° in group A. While they were (34.6±2.3)°and (15.7±1.2)° in group B.There were no statistically significant differences between the two groups(P＞0.05).The AOFAS ankle-hindfoot score in group A was(90.4±6.7)points，and was(91.3±7.6)points in group B.There was no significant difference between the two groups(P＞0.05).According to the Arner-lindholm assessment，the excellent and good rate in group A was 81.8% and 97.1% in group B.Group A was lower than group B，and the difference was statistically significant(P＜0.05).Conclusion It is a feasible method to treat Kuwade type Ⅲ，Ⅳ chronic achilles tendon rupture by cryopreserved allogeneic tendon.It is beneficial to the patients to resume daily activities earlier and fewer complications.
［1］刘文科，聂茂，王卓群，等.陈旧性跟腱断裂的治疗现状与展望［J］.中国矫形外科杂志，2019，27(18)：1687-1691.
［2］Singh D.Acute achilles tendon rupture［J］.Br J Sports Med，2017，51(15)：1158-1160.
［3］姜健，孙强，苏云，等.改良跟腱内侧弧形切口联合改良垂直间断褥式缝合法治疗新鲜跟腱断裂［J］.实用骨科杂志，2019，25(1)：84-86.
［4］卜晗，张梅刃，蒋际钊，等.基于跟腱断裂Kuwade分型采用三种自体肌腱移植重建方法的临床疗效分析［J］.中华移植杂志(电子版)，2014，8(2)：85-89.
［5］刘广炼，李彩会，邵新中.陈旧性跟腱断裂病因及手术治疗进展［J］.临床误诊误治，2018，31(12)：109-113.
［6］Kuwada GT.Classification of tendo achillis rupture with consideration of surgical repair techniques［J］.J Foot Surg，1990，29(4)：361-365.
［7］巫宗德，张强，刘峻宏，等.经皮减张端端瘢痕重叠缝合术治疗陈旧性跟腱断裂临床疗效观察［J］.四川医学，2020，41(10)：1047-1050.
［8］张海波，王义生.VY肌腱瓣修复治疗KuwadeⅢ型陈旧性跟腱断裂的疗效观察［J］.中国矫形外科杂志，2011，19(20)：1743-1745.
［9］郝云甲，王爱国，范家强，等.全关节镜下自体半腱肌及股薄肌肌腱修复MyersonⅢ型陈旧性跟腱断裂的疗效分析［J］.中华外科杂志，2020，58(9)：718-722.
［10］Abubeih H，Khaled M，Saleh WR，et al.Flexor hallucis longus transfer clinical outcome through a single incision for chronic achilles tendon rupture［J］.Int Orthop，2018(2018)：20-27.
［11］白文博，张若肖，梁晓军，等.单切口与双切口踇长屈肌腱转位治疗陈旧性跟腱断裂的疗效比较［J］.中华骨与关节外科杂志，2020，13(9)：761-766.
［12］王慧娟，陈少鹏，孙亚宁，等.同种异体肌腱修复陈旧性跟腱断裂［J］.足踝外科电子杂志，2015，2(3)：24-26.
［13］朱付平，王林华，李武平，等.同种异体肌腱皮桥下修复陈旧性跟腱断裂的疗效观察［J］.中国骨与关节损伤杂志，2018，33(10)：1102-1103.
［14］李飞，齐玲，苗旭东，等.腓肠肌逆转筋膜瓣结合踇长屈肌腱转位治疗Myerson Ⅲ型陈旧性跟腱断裂［J］.足踝外科电子杂志，2017，4(4)：31-34.
［15］Mistry H，Metcalfe A，Colquitt J，et al.Autograft or allograft for reconstruction of anterior cruciate ligament：A health economics perspective［J］.Knee Surg Sports Traumatol Arthrosc，2019，27(6)：1782-1790.
［16］Braunstein M，Baumbach SF，Boecker W，et al.Development of an accelerated functional rehabilitation protocol following minimal in-vasive Achilles tendon repair［J］.Knee Surg Sports Traumatol Arthrosc，2018，26(3)：846-853.
［17］Padanilam TG.Chronic achilles tendon ruptures［J］.Foot Ankle Clin，2009，14(4)：711-728.
［18］Boisgérault F，Liu Y，Anosova N，et al.Differential roles of direct and indirect allorecognition pathways in the rejection of skin and corneal transplants［J］.Transplantation，2009，87(1)：16-23.
［19］孙燕琨，张友乐，孙磊，等.深低温冷冻肌腱细胞活性的研究［J］.中华手外科杂志，2006，22(3)：133-136.
［20］杨宇升，徐洪伟，黎立，等.三种肌腱重建前交叉韧带的组织学比较［J］.中国矫形外科杂志，2020，28(7)：643-648.
［21］Arnout N，Myncke J，Vanlauwe J，et al.The influence of freezing on the tensile strength of tendon grafts：a biomechanical study［J］.Acta Orthop Belg，2013，79(4)：435-443.
［22］Lee AH，Elliott DM.Freezing does not alter multiscale tendon mechanics and damage mechanisms in tension［J］.Ann N Y Acad Sci，2017，1409(1)：85-94.
［23］Quirk NP，Lopez De Padilla C，De La Vega RE，et al.Effects of freeze-thaw on the biomechanical and structural properties of the rat Achilles tendon［J］.J Biomech，2018(81)：52-57.
［24］Hongjie H，Xinyan S，Xiaoguang Z，et al.Effects of multiple freeze-thaw on biomechanical properties of human allograft tendons［J］.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi，2011，25(2)：243-246.
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