摘要
目的比较传统切开跟腱吻合术、经皮微创跟腱吻合术以及应用跟腱吻合器有限切开术治疗新鲜闭合性跟腱断裂的疗效,为临床治疗方式的选择提供参考依据。方法 2007年12月-2010年3月将69例符合纳入标准的新鲜闭合性跟腱断裂患者随机分为3组,其中采用传统切开跟腱吻合术23例(传统切开组),经皮微创跟腱吻合术23例(经皮微创组),应用跟腱吻合器有限切开治疗23例(有限切开组)。3组患者性别、年龄、损伤机制、美国足踝外科协会(AOFAS)踝-后足评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果经皮微创组及有限切开组住院时间及失血量明显优于传统切开组(P<0.01)。术后传统切开组发生2例(8.7%)切口感染坏死,其余两组患者切口均Ⅰ期愈合;传统切开组术后腱旁组织并发症发生率高于其余两组(P<0.05)。经皮微创组及有限切开组各1例(4.3%)发生跟腱再断裂,传统切开组跟腱再断裂发生率(0)低于其余两组(P<0.05)。69例均获随访,随访时间12～18个月,平均14.9个月。术后12个月3组踝关节AOFAS评分均>90分,较同组术前显著改善(P<0.05),组间比较差异无统计学意义(P>0.05)。结论 3种手术方式均能有效治疗新鲜跟腱断裂,有限切开或经皮微创手术方法创伤小,伤口愈合好,住院时间少,术后腱旁组织并发症少,但跟腱再断裂风险增加。
Objective To compare the effectiveness of the 3 methods （traditional open Achilles tendon anastomosis, minimally invasive percutaneous Achilles tendon anastomosis, and Achilles tendon anastomosis limited incision） for acute Achilles tendon rupture so as to provide a reference for the choice of clinical treatment plans. Methods Between December 2007 and March 2010, 69 cases of acute Achilles tendon rupture were treated by traditional open Achilles tendon anastomosis （traditional group, n=23）, by minimally invasive percutaneous Achilles tendon anastomosis （minimally invasive group, n=23）, and by Achilles tendon anastomosis limited incision （limited incision group, n=23）. There was no significant difference in gender, age, mechanism of injury, and American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score between 3 groups （P 〉 0.05）. Results Minimally invasive group and limited incision group were significantly better than traditional group in hospitalization days and blood loss （P 〈 0.01）. Incision infection occurred in 2 cases of traditional group, and healing of incision by first intention was achieved in all patients of the other 2 groups, showing significant difference in the complication rate （P 〈 0.05）. Re-rupture of Achilles tendon occurred in 1 case （4.3%） of minimally invasive group and limited incision group respectively; no re-rupture was found in traditional group （0）, showing significant difference when compared with the other 2 groups （P 〈 0.05）. All cases were followed up 12-18 months with an average of 14.9 months. The function of the joint was restored. The AOFAS score was more than 90 points in 3 groups at 12 months after operation, showing no significant difference among 3 groups （P 〉 0.05）. Conclusion The above 3 procedures can be used to treat acute Achilles tendon rupture. However, minimally invasive percutaneous Achilles tendon anastomosis and Achilles tendon anastomosis limited incision have the advantages of less invasion, good healing, short hospitalization days, and less postoperative complication, and have the disadvantage of increased risk for re-rupture of Achilles tendon after operations.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2012年第7期814-818,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
新鲜跟腱断裂
闭合性损伤
跟腱吻合术
Acute Achilles tendon rupture Closed injury Achilles tendon anastomosis
