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[目的]探索关节镜下解剖性跟腱延长微创治疗儿童马蹄足的手术方法。[方法]对2013年1月-2014年1月收治的儿童马蹄足患儿12例16足,采用跟腱中段小切口关节镜入路,镜下经皮依次切断跟腱比目鱼肌肌腱跟骨止点部分和腓肠肌肌腱近端,背伸患足,使之达背伸20°~30°。自关节镜中段切口处以可吸收缝合器缝合已松解的跟腱,背伸位石膏固定6周。6周后负重功能锻炼。术后随访测量患足背伸角度,并行AOFAS踝-后足评分。[结果]所有病例平均随访12.6个月,足背伸较术前有明显改善,踝关节活动范围平均术前背伸(5.9±4.7)°,术后背伸(24.8±3.1)°,术前与术后比较差异有统计学意义(P<0.01),术后与随访时比较差异无统计学意义(P>0.05)。关节镜组与非关节镜组术后6个月随访时患足背伸活动度及AOFAS评分对比,关节镜下组较传统长切口组有优势;AOFAS踝-后足评分比较,与经皮跟腱延长术未见明显差异。关节镜下跟腱延长未见严重并发症,行走功能明显改善,跟腱固定处无不适,患足背伸肌力良好。[结论]关节镜下跟腱延长术,可镜下观察跟腱解剖分型,根据不同分型,实施确切跟腱延长松解,充分松解跖肌腱,切口小,创伤小,并发症少,操作安全,疗效满意。
[Objective] To explore the surgical method of anatomic Achilles tendon extension and minimally invasive treatment of children ’s clubfoot under arthroscopy. [Methods] Twelveteen children with horseshoe heel in January 2013-January 2014 were treated with small incision arthroscopy in the middle of the Achilles tendon. Twelve months later, the tendons of the tendon soleus Point and the proximal part of the gastrocnemius tendon, dorsal extension of the foot, so that the dorsiflexion of 20 ° ~ 30 °. From the incision at the middle of the arthroscopy sutured resorbed Achilles tendon, dorsal plaster fixed for 6 weeks. After 6 weeks of weight-bearing exercise. Postoperative follow-up measurement of foot dorsiflexion angle, parallel AOFAS ankle - hind foot score. [Results] All patients were followed up for an average of 12.6 months. The dorsiflexion of the dorsiflexion was significantly improved in all cases. The ankle range of motion was (5.9 ± 4.7) °, dorsiflexion (24.8 ± 3.1) °, There was no significant difference between postoperative and postoperative follow-up (P> 0.05). Arthroscopic group and non-arthroscopic group 6-month follow-up of patients with foot dorsiflexion activity and AOFAS score comparison, arthroscopic group than the traditional long-term incision group has advantages; AOFAS ankle-hindfoot score compared with the transcutaneous heel Tendon extension no significant difference. Arthroscopic Achilles tendon extension without serious complications, significantly improved walking function, Achilles tendon fixed no uncomfortable, good foot dorsiflexion. [Conclusion] Arthroscopic Achilles tendon extension can be used to observe the anatomic classification of the Achilles tendon. According to the different types of Achilles tendon, the Achilles tendon is extended and released, and the plantar tendon is fully released. The incision is small with less trauma and less complications. Safe operation, satisfactory results.