外傷性腓肌腱脫位之手術治療

Surgical Procedure of Traumatic Dislocation of the Peroneal Tendons

姜傑(Chieh Chiang) ； 蔣漢民(Han-Min Chiang) ； 敖曼冠(Man-Kuan Au) ； 王世杰(Shyu-Jye Wang) ； 白偉民(Wi-Ming Pai) ； 梁鉑鈴(Po-Ling Laing)

《Journal of Orthopaedic Surgery Taiwan》 6卷2期 (1989/06) Pp. 80-84

摘要

外傷性腓肌腱脫位或半脫位乃較為罕見的病例，在這一世紀以來已有相當程度的瞭解。急性發病的患者，往往因踝部瘀血且腫脹而被誤診為踝扭傷，所以若病人在踝部 外翻時併有後踝部疼痛者，則要高度懷疑量否為腓肌腱脫位。慢性復發性患者，當足部背屈時可見腓肌腱向前脫位。主要發病機轉可能是當足部突然背屈且伴有腓肌強烈收縮造成了上腓骨支持帶的傷害而使得腓肌腱向前脫位。
手術的方洲當繁多，三軍總醫院自民國74年1月至77年3月，共有六例復發性腓肌腱脫位患者接受以跟腓韌帶繞位手術來重建新的上腓骨支持帶，也就是取下跟腓韌帶在跟骨附著的一小塊骨頭，向上繞過腓肌腱後再釘回原處，再以一小螺絲固定骨頭，最後以石膏固定四週。本手術方法簡單且近乎生理，避免了不必要的粘黏，組織癖痕及肌腱韌炎磨損，在平均追蹤27.1個月後，其結果相當令人滿意!

關鍵字

腓肌腱脫位 ； 跟腓韌帶繞位手術

並列摘要

Traumatic dislocation or subluxation of the peroneal tendons over the lateral malleolus is uncommon and has been recongnized for a century or so. Acute injuries are most often misdiagnosed as “ankle sprain’, because of pain, swelling and ecchymosis may hinder early diagnosis; however, intense retromalleolar pain on active eversion is a specific, highly suggestive finding. In chronic cases, marked dislocation with snapping of the tendons may occur during dorsiflexion of the foot and the patient may have a feeling of instability. The mechanism responsible for the injury of the superior peroneal retinaculum is probable a sudden, forceful dorsiflexion of the foot accompanied by a powerful contraction of the peroneal muscles.
Numerous operations have been designed, which may indicate an unsolved problem. Six cases of post-traumatic recurrent dislocation of the peroneal ten dons were operated on between Jan. 1985 and March 1988. The injuried superior peroneal retinaculum was reconstructed by transposition of the calcaneofibular ligament of the lateral side of the peroneal tendons. The clacaneal insertion of the calcaneofibular ligament was mobilized with a small bone block and reinserted after the transposition. After the operation the ankle joint was immobilized for four weeks in a short-leg plaster cast, and after an average follow-up of 27.1 months all the results were satisfactory.