中国修复重建外科杂志

中国修复重建外科杂志

层叠斜面缝合法修复新鲜闭合性跟腱断裂早期疗效观察

查看全文

目的 介绍一种修复新鲜闭合性跟腱断裂的改良方法,初步探讨其临床效果。 方法 2011 年 3 月—2015 年 9 月,采用层叠斜面缝合法手术修复 8 例(8 侧)新鲜闭合性跟腱断裂。患者均为男性;年龄 22~58 岁,平均 39.3 岁。为运动中损伤,局部无直接暴力。提踵试验及 Thompson 试验均呈阳性。彩色多普勒超声或 MRI 检查确定跟腱完全断裂,断端距跟骨止点 2~5 cm,平均 3.3 cm。伤后至手术时间为 2~12 d,平均 4.1 d。采用后正中偏内侧纵向切口暴露,将跟腱断端在冠状面上分 3 层,断端梳理成条带状,交错层叠,跟腱纤维斜面侧侧缝合。术后踝关节跖屈保护位外固定,早期开始康复锻炼。 结果 手术时间 70~135 min,平均 99 min;术中出血量 5~30 mL,平均 15.6 mL。除 1 例拆线后切口部分裂开,经换药愈合外,其余切口均 Ⅰ 期愈合,无感染发生。8 例均获随访,随访时间 6~50 个月,平均 30.5 个月。无腓肠神经损伤、局部疼痛及下肢深静脉血栓形成等并发症发生。所有患者均恢复至跟腱断裂前运动水平,行走正常,提踵有力,未发生跟腱再断裂。与健侧对比,踝关节活动度背伸减少 0~6°,平均 3°;跖屈减少 1~5°,平均 2°。末次随访时按照 Arner-Lindholm 疗效评定标准,优 7 例,良 1 例,优良率 100%。 结论 层叠斜面缝合法操作简便,无需特殊器械,可提供早期康复锻炼的抗拉强度,患者恢复快,早期疗效较好。

Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.

关键词: 闭合性跟腱断裂; 层叠斜面缝合法; 早期疗效

Key words: Closed Achilles tendon rupture; laminated bevel suturing technique; preliminary effectiveness

引用本文: 孙太存, 鲁彪, 曹兴兵, 陈海宁, 徐晓峰, 崔学文. 层叠斜面缝合法修复新鲜闭合性跟腱断裂早期疗效观察. 中国修复重建外科杂志, 2017, 31(12): 1447-1451. doi: 10.7507/1002-1892.201704117 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized controlled study comparing surgical and nonsurgical treatments using validated outcome measure. Am J Sports Med, 2010, 38(11): 2186-2193.
2. Wang D, Sandlin MI, Cohen JR, et al. Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12, 570 patients in a large healthcare database. Foot Ankle Surg, 2015, 21(4): 250-253.
3. Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma, 2003, 54(6): 1171-1180.
4. van der Eng DM, Schepers T, Goslings JC, et al. Rerupture rate after early weight bearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg, 2013, 52(5): 622-628.
5. 中国医师协会骨科医师分会, 中国医师协会骨科医师分会《急性跟腱断裂循证临床诊疗指南》编辑委员会. 中国医师协会骨科医师分会循证临床诊疗指南: 急性跟腱断裂循证临床诊疗指南. 中华外科杂志, 2015, 53(8): 561-563.
6. Sadoghi P, Rosso C, Valderrabano V, et al. Initial Achilles tendon repair strength——synthesized biomechanical data from 196 cadaver repairs. Int Orthop, 2012, 36(9): 1947-1951.
7. 王东, 孙彤. 改良腓肠肌腱膜瓣翻转修复新鲜跟腱断裂的临床疗效. 中华医学杂志, 2012, 92(17): 1206-1208.
8. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg (Am), 1999, 81(7): 1019-1036.
9. Longo UG, Petrillo S, Maffulli N, et al. Acute Achilles tendon rupture in athletes. Foot Ankle Clin, 2013, 18(2): 319-338.
10. Singh D. Acute Achilles tendon rupture. BMJ, 2015, 351: h4722.
11. Jones MP, Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon rupture: key findings from a recent cochrane review. J Bone Joint Surg (Am), 2012, 94(12): e88.
12. Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
13. 陈华, 郝明, 张巍, 等. 经通道辅助缝合系统微创修复急性闭合跟腱断裂的疗效观察. 中国修复重建外科杂志, 2015, 29(1): 35-38.
14. Bartel AF, Elliott AD, Roukis TS. Incidence of complications after Achillon mini-open suture system for repair of acute midsubstance achilles tendon ruptures: a systematic review. J Foot Ankle Surg, 2014, 53(6): 744-746.
15. Thomopoulos S, Parks WC, Rifkin DB, et al. Mechanisms of tendon injury and repair. J Orthop Res, 2015, 33(6): 832-839.
16. Sorrenti SJ. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair. Foot Ankle Int, 2006, 27(6): 407-410.
17. Jaakkola JI, Beskin JL, Griffith LH, et al. Early ankle motion after triple bundle technique repair vs. casting for acute Achilles tendon rupture. Foot Ankle Int, 2001, 22(12): 979-984.
18. Bevoni R, Angelini A, D’Apote G, et al. Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol. Injury, 2014, 45(8): 1268-1274.
19. Olsson N, Petzold M, Brorsson A, et al. Predictors of clinical outcome after acute Achilles tendon ruptures. Am J Sports Med, 2014, 42(6): 1448-1455.