应用同种异体肌腱治疗KuwadeⅢ、Ⅳ型陈旧性跟腱断裂

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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.

Key words： chronic achilles tendon rupture allogeneic tendon cryopreservation gastrocnemius "V-Y" tendon flap extension gastrocnemius tendon flap transfer

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