Objective To investigate the effects of gastrocnemius aponeurosis subvolution for repairing the old Achilles tendon. Methods 18 cases of old Achilles tendon rupture were repaired by gastrocnemius aponeurosis subvolution. An 8 ~ 10cm long and 3 cm wide gastrocnemius fascia flap pedicle was cut with fun-dus remaining 1.5 - 2cm above the broken ends of the Achilles tendon in the middle leg. In the center of the Achilles tendon, a vertical incision was made for the gastrocnemius fascia flap to be pulled through. And then the flap folded down on both sides around the Achilles tendon to the proximal and distal ends and the defects. Then the Achilles tendon was rebuilt by the Bunnell wire method with the ankle plantar flexion of about 20°. Results There were 3 cases suffered from the delayed healing, but no skin incision or tendon necrosis, no deep infection or further fracture case. All cases were followed up for 24 ~ 40 months, with an average of 26 months. According to the Amer-lindholms evaluation criteria, 13 got excellent results and 5 good. Conclusion It is a good method of the gastrocnemius aponeurosis subvolution for treating the old Achilles tendon rupture with advantages of simple manipulation, firm fixation, high union rate and low complications.%目的 探讨应用腓肠肌腱膜翻转法治疗陈旧性跟腱断裂的疗效.方法 对18例陈旧性跟腱断裂患者应用腓肠肌腱膜翻转术重建跟腱.术中于小腿中部腓肠肌腱膜-肌移行处切取一条长8～ l0 cm、宽3 cm带蒂腓肠肌筋膜瓣,其基底留在离断端上方约1.5～2 cm处,于蒂上方跟腱中心作一纵切口,把腱膜瓣从此切口中穿过,再反折向下,由跟腱两侧向浅面包绕跟腱远近端及其缺损.自跟骨结节撕脱者将跟骨结节咬成粗糙面,腱膜条拉紧,根据缺损长度修剪腱膜条远端,使之与跟骨结节相接触.然后用Bunnell抽出钢丝法将重建跟腱拉紧,使踝关节跖屈约20°.结果 本组有3例切口延迟愈合,无皮肤及肌腱坏死、无深部感染及再断裂病例.所有患者平均随访26( 24～40)个月,按Arner-Lindholm标准评定,优13例,良5例,临床疗效良好.结论 腓肠肌腱膜翻转术治疗陈旧性跟腱断裂具有手术操作简单、固定牢固、愈合率高、并发症少等优点,是一种较为理想的重建方法.
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