摘要
背景:目前可运用的各类跟腱断裂微创修复技术仍存在跟腱缝合吻接质量不确切、腓肠神经损伤或治疗费用高等缺点,不利于临床推广。目的:探讨应用鞘外编织、鞘内吻接技术治疗新鲜闭合性跟腱断裂的临床疗效。方法:对2015年9月至2019年7月应用鞘外编织、鞘内吻接技术治疗的23例急性闭合性跟腱断裂患者资料进行回顾性分析,男18例、女5例,年龄17~38岁,平均(33.5±4.6)岁。术后观察有无切口感染、皮肤坏死、腓肠神经损伤及二次断裂并发症发生;术后1周复查MRI,在影像学下评估跟腱吻接情况,观察吻接后的跟腱连续性,并在矢状面测量吻接段跟腱厚度,与健侧相同部位的跟腱厚度进行对比;术后6个月采用Amer-Lindholm评价标准进行疗效评估。结果:23例患者术后切口均甲级愈合,无感染及皮肤坏死、腓肠神经损伤、跟腱二次断裂发生。术后1周复查MRI显示跟腱连续性好,患侧吻接段跟腱厚度平均(7.92±0.46)mm,健侧相同部位跟腱厚度平均(5.87±0.42)mm,患侧较健侧平均增粗2.05 mm,差异有统计学意义(t=113.89,P<0.001)。术后6个月按Amer-Lindholm疗效评价标准,优21例,良2例,差0例,优良率100%。结论:应用鞘外编织、鞘内吻接技术治疗新鲜闭合性跟腱体部断裂术式简单,切口小,并发症少,跟腱吻接质量确切,跟腱厚度恢复佳,术后效果良好。
Background:The current literature on minimally invasive techniques for repairing Achilles tendon rupture lacks a positive description of the quality of anastomosis.At the same time,sural nerve injury and high treatment costs are regarded as its shortcomings,so it is not easy to promote in clinical treatment.Objective:To investigate the clinical efficacy of extra-muscular sheath woven and intrathecal anastomosis technique in treatment of fresh closed Achilles tendon rupture.Methods:From September 2015 through July 2019,23 patients with acute close rupture of Achilles tendon treated with extra-muscular sheath woven and intrathecal anastomosis technique were taken for suture repair.18 males and 5 females with the average age of(33.5±4.6)years(range,17-38 years).The complications of wound were observed as infection,skin necrosis,sural nerve injury and secondary ruptures.One week after operation,MRI was used to observe the integrity of Achilles tendon.Not only the continuity,but also the thickness of the Achilles tendon was measured in the sagittal plane,and compared with that of the Achilles tendon in the same part of the healthy side.Amer-Lindholm evaluation criteria were used to evaluate the efficacy of the operation 6 months after surgery.Results:All patients had the incisions primarily healed,and had no infection,skin necrosis,sural nerve injury and secondary ruptures.At one week after the operation,MRI showed a good continuity of Achilles tendon;the average thickness of the ill side Achilles tendon was(7.92±0.46)mm,and the thickness of the healthy side Achilles tendon was(5.87±0.42)mm;the ill side was 2.05 mm thicker than the healthy side(t=113.89,P<0.001).According to Amer-Lindholm efficacy evaluation criteria,at 6 months after surgery there were 21 patients as excellent,2 patients as good,and none of the poor,and the excellent and good rate was 100%.Conclusions:Extra-muscular sheath woven and intrathecal anastomosis in treatment of fresh closed Achilles tendon rupture is simple,with small incision and few complications.It is good for quality of Achilles tendon anastomosis,recovery of Achilles tendon thickness and postoperative outcomes.
作者
赵东旭
王铁英
吴雪海
吕国胜
霍鑫
ZHAO Dongxu;WANG Tieying;WU Xuehai;Lyu Guosheng;HUO Xin(Department of Orthopaedics,Second Hospital of Chifeng City,Chifeng 024000,Inner Mongolia,China)
出处
《中华骨与关节外科杂志》
2021年第8期698-702,共5页
Chinese Journal of Bone and Joint Surgery
关键词
跟腱
断裂
微创
Achilles Tendon
Fracture
Minimally Invasive
作者简介
通信作者:赵东旭,E-mail:zdxdoctor@163.com
