跟腱再断裂原因临床探讨

Clinical Discussion of Reasons in 16 Cases of Achilles Tendon Re-abruption

目的:探讨跟腱再断裂原因及相关防治措施与临床结果。方法:对16例跟腱再断裂患者,分析其断裂原因,再次手术清除断端瘢痕组织,Bennett直接缝合9例;V-Y延长术后,断端直接缝合5例,跟腱附着点再断裂2例,先作跟骨结节骨隧道,再用小钢丝做Bennett抽丝缝合,其周围用丝线缝合加强固定。术后踝关节保持跖屈位,屈膝30°,石膏管型固定6周后,改成短腿石膏外固定4周,再穿高跟矫形鞋2-3月,1年内禁止过量活动。结果:跟腱全部愈合,踝关节功能优12例,良2例,差2例。结论:只要严格手术操作,掌握缝合技巧,术后处理得当,跟腱再断率将明显下降。

Objective： To discuss reasons of Achilles tendon re-abruption and the way of prevention and treatment, and evaluate the clinical outcomes. Methods. The clinic data of 16 cases of Achilles tendon re-abruption were analyzed. After careful debridement, nine cases were treated by Bennett suture with 10 # nesis, and five cases were treated by Achilles tendon V-Y prolongation operation and Bennett suture. In the other two cases, whose Achilles tendons were broken on the insertion, by punching a bone tunnel in calcaneal eminence and with a thin wire, Achilles tendons were sutured through the tunnel and fixed by suturation with 10# nesis around the calcaneal eminence. After the operation, the ankle flextion was maintained by cast plast fixation for eight weeks, then wore an orthotic high-heel shoe for two or three months, and without acute exercise in one year. Results. All the Achilles tendons healed, and ankle function examination showed that 12 cases were excellent, three cases were good, and one case was in ankle function. Conclusion： Proper operation techniques and post-operation treatment could decrease the probability of Achilles tendon re-abruption and enhance the healing.