Biomechanical Evaluation of the Jones Tendon Transfer

瓊氏肌腱轉移手術的生物力學評估

王崇禮(Chung- Li Wang) ； 恩伊‧歐基瑞基(Enyi Okereke)

《Journal of Orthopaedic Surgery Taiwan》 10卷4期 (1993/12) Pp. 423-427

摘要

本文目的乃利用脛足角度與第一蹠骨跟骨角度來評估瓊氏肌腱轉移手術﹝包刮有吳家上足底筋膜切斷術﹞的治療成效。我們使用八個新鮮冷凍下肢標本來作研究，在superior extensor retinaculum以上的軟組織除肌腱與韌帶外加以剃除，每一標本利用脛髓內釘懸空固定，使足部能上下活動，經由滑輪系統，加以伸大趾長肌以一公斤之拉力，模仿肌肉收縮之拉力，手術方法包刮大腳趾趾間關節固定術，並將伸大趾長肌轉至第一蹠骨頸部附近。接著再做足底筋膜切斷術。在各個階段都照足部側面的X光，以量脛足角度與第一蹠骨跟骨角度。脛足角度與第一蹠骨跟股角度在術前分別是86.1(SD，5.9)度與127.0(SD，21.4)度，在瓊氏手術後，分別變成73.8(SD，6.2)度與134.0(SD，4.9)度，表示在脛足角度改善了12.4%，而再第一蹠骨跟骨手術只改善6.1%，至於足底筋膜切斷術再本實驗並沒有改善脛足角度與第一蹠跟骨角度。

關鍵字

瓊氏肌腱轉移術 ； 生物力學評估

並列摘要

The purpose of this study is to evaluate the effect of the Jones procedure with or without plantar fasciotomy on the tibiopedal and the first metatarsocalcaneal angles. Eight fresh-frozen below-knee cadaveric specimens were stripped of soft tissue above the superior extensor retinaculum; the ligaments and tendons were preserved. Each specimen was mounted on a testing frame via an intramedullary rod cemented into the tibia with the foot unsupported. A 1-kg force was applied to the extensor hallucis longus through a pulley system, simulating in vivo muscle contraction. The operative procedure consisted of the fusion of the hallux interphalangeal joint and transfer of the extensor hallucis longus tendon to the first metatarsal neck. A plantar fasciotomy was subsequently performed. Preoperative and postoperative lateral radiographs were obtained to measure the tibiopedal and first metatarsocalcaneal angles. Preoperative tibiopedal and first metatarsocalcaneal angles averaged 86.1 (SD,5.9) degrees and 127.0(SD,21.4) degrees, respectively. After Jones tendon transfer, they changed to be 73.8 (SD,6.2) degrees and 134.0 (SD,4.9) degrees, respectively. These results represent a 12.4% decrease in tibiopedal angle, while the first metatarsocalcaneal angle was increased by 6.1%. The plantar fasciotomy resulted in no additional changes to the tibiopedal and first metatarsocalcaneal angles caused by the initial Jones procedure.

並列關鍵字

Jones tendon transfer ； biomechanical evaluation