Reconstruction of Chronic Achilles Tendon Rupture with The Ipsilateral Semitendinosus Tendon Graft - A Case Report and Literature Review

以同側半腱肌腱重建慢性阿基里斯腱斷裂的患者－個案報告及文獻回顧

曾文楷(Wen-Kai Tseng) ； 蒲啟明(Chi-Ming Pu)

《臺灣整形外科醫學會雜誌》 28卷3期 (2019/09) Pp. 227-237

摘要

Background: Achilles tendon ruptures could be divided into the acute and chronic types. Acute Achilles tendon rupture is usually treated with primary repair. However, the management of chronic Achilles tendon rupture has been controversial. Aim and Objectives: We aimed to present a case of chronic Achilles tendon rupture that has been reconstructed with a semitendinosus tendon graft. Further, we reviewed the literature on the different reconstruction methods. Materials and Methods: The patient was a 54-year-old man with a history of coronary artery disease treated with percutaneous transluminal coronary angioplasty, peripheral artery disease treated with percutaneous transluminal angioplasty, hypertension, and uremia requiring kidney transplantation (which resulted in chronic rejection requiring regular hemodialysis). He presented with left heel pain and swelling persisting for 3 months. On history taking, he was noted to have accidentally been kicked in the foot by another person. As a result, he could only stand and walk for a short period. He visited our clinic for consultation. Physical examination showed an about 2-cm palpable gap in the left heel, suggesting total rupture of the Achilles tendon. The result of magnetic resonance imaging was compatible with our diagnosis. We performed Achilles tendon reconstruction with a semitendinosus tendon graft. A 6-cm gap was seen intraoperatively. A semitendinosus tendon graft was harvested, using a tendon stripper, from the ipsilateral thigh through an incision on the pes anserinus. Results: After the operation, a left leg cast was applied for 6 weeks. The patient had good functional recovery. He achieved nearly full range of motion in the left ankle. He could tolerate walking and climbing the stairs without a crutch. Conclusion: There are different methods for reconstructing chronic Achilles tendon ruptures. We reported a case with excellent results by semitendinosus tendon graft reconstruction for chronic Achilles tendon rupture. Further studies including large randomized trials are needed to validate the functional and clinical outcomes.

關鍵字

chronic Achilles tendon rupture ； semitendinosus tendon graft reconstruction

並列摘要

背景：阿基里斯腱斷裂可以分為急性及慢性，急性阿基里斯腱斷裂通常直接縫合治療，但慢性阿基里斯腱斷裂的治療方法目前並沒有共識。目的及目標：藉由報告一個以同側半肌腱重建慢性阿基里斯腱斷裂的個案，探討此類病人可能發生原因及治療上的選擇。材料及方法：一位五十四歲男性有末期腎病變，曾經接受過腎臟移植但後來發生慢性排斥，目前規則接受血液透析治療。此次因為左腳跟疼痛三個月而來門診求診，理學檢查及核磁共振檢查診斷為慢性阿基里斯腱斷裂。手術清創後阿基里斯腱斷裂的距離為六公分，我們以同側半肌腱進行重建。結果：手術後以石膏固定約六週，之後開始負重及復健。術後病人恢復狀況良好，腳踝關節活動度正常，並且可在不需枴杖輔助的情況下行走及爬樓梯。結論：重建慢性阿基里斯腱斷裂的方法有很多種，我們報告了一個成功以同側半肌腱重建慢性阿基里斯腱斷裂的個案，患者術後活動恢復良好且無相關併發症。若患者有大於六公分的慢性阿基里斯腱斷裂可以考慮以此方法重建，但未來仍需大型隨機對照試驗去比較不同方法間的優劣。