中国修复重建外科杂志

中国修复重建外科杂志

改良缝合法治疗急性闭合性跟腱断裂的疗效分析

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目的探讨使用改良缝合法治疗急性闭合性跟腱断裂的临床疗效。方法2013 年 12 月—2016 年 12 月,采用改良缝合法治疗 29 例急性闭合性跟腱断裂。男 23 例,女 6 例;年龄 22~45 岁,平均 34 岁。患者均为运动损伤,其中左侧 22 例、右侧 7 例。术前美国足踝外科协会(AOFAS)踝与后足功能评分为(44.6±3.6)分;参照 Amer-Lindholm 疗效评定标准评价均为差。MRI 检查显示跟腱完全断裂。结果手术时间 35~62 min,平均 46 min;术中出血量 7~15 mL,平均 10 mL。术后切口均Ⅰ期愈合,无腓肠神经损伤发生。患者均获随访,随访时间 5~38 个月,平均 18.4 个月。术后 3 个月,AOFAS 踝与后足功能评分为(93.1±4.3)分,与术前比较差异有统计学意义(t=–49.581,P=0.000)。参照 Amer-Lindholm 疗效评定标准评价,获优 24 例、良 5 例,优良率 100%;与术前比较差异有统计学意义(Z=–7.294,P=0.000)。MRI 检查示跟腱连续性完整。随访期间均无跟腱再断裂发生。结论改良缝合法治疗急性闭合性跟腱断裂具有创伤小、再断裂发生率低、腓肠神经损伤风险低及功能恢复较好等优点。

ObjectiveTo investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture.MethodsBetween December 2013 and December 2016, 29 cases with acute closed Achilles tendon rupture were treated with modified suture technique. There were 23 males and 6 females with an average age of 34 years (range, 22-45 years). All patients were sport injuries. The injury located at left side in 22 cases and right side in 7 cases. American Foot and Ankle Surgery Association (AOFAS) ankle and hind foot function score was 44.6±3.6. According to the Amer-Lindholm criteria, 29 cases were rated as poor. MRI showed the complete rupture of the Achilles tendon.ResultsThe operation time was 35-62 minutes (mean, 46 minutes). The intraoperative blood loss volume was 7-15 mL (mean, 10 mL). The incisions healed by first intention, and no sural nerve injury occured. All patients were followed up 5-38 months (mean, 18.4 months). AOFAS ankle and hind foot function score was 93.1±4.3 at 3 months after operation, showing significant difference when compared with the preoperative value (t=–49.581, P=0.000). According to the Amer-Lindholm criteria, the results were excellent in 24 cases and good in 5 cases, and the excellent and good rate was 100%; there was significant difference between pre- and post-operation (Z=–7.294, P=0.000). MRI showed the continuous and integrity of Achilles tendon. No Achilles tendon rupture recurred during the follow-up period.ConclusionModified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery.

关键词: 改良缝合法; 急性跟腱断裂; 闭合性损伤

Key words: Modified suture technique; acute Achilles tendon rupture; closed injury

引用本文: 詹俊锋, 方家刘, 张积森, 程文丹, 吕浩, 荆珏华. 改良缝合法治疗急性闭合性跟腱断裂的疗效分析. 中国修复重建外科杂志, 2017, 31(8): 952-956. doi: 10.7507/1002-1892.201702090 复制

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