利用跟腱龙行微创有限切开经皮技术修复急性跟腱断裂的近期临床疗效

SHORT-TERM CLINICAL EFFECTS OF MINI-INVASIVE SURGICAL METHOD BY ACHILLON IN REPAIR OF ACUTE ACHILLES TENDON RUPTURE

目的评价采用跟腱龙行微创有限切开经皮技术修复急性跟腱断裂的近期临床疗效。方法 2009年12月-2010年2月,收治11例11足跟骨结节上方2～8cm急性跟腱断裂患者。男8例,女3例;年龄23～58岁,平均35.4岁。跳跃伤9例,玻璃割伤1例,摔伤1例。Thompson试验均为阳性。根据美国足踝外科协会(AOFAS)踝-后足疗效评价标准评分为(53.19±6.31)分。MRI检查示跟腱裂隙为1～5cm,平均3.8cm。受伤至手术时间为2～7d,平均3.6d。术中于跟腱内侧作3～4cm长切口,采用跟腱龙修复跟腱断端。术后行早期康复锻炼。结果手术时间27～58min,平均38min。住院时间2～3d,平均2.5d。术后2例切口表面感染,经换药对症处理后愈合;其余切口均Ⅰ期愈合。术后11例均获随访,随访时间5～8个月,平均6.7个月。跟腱断裂无复发,术后3个月患者均恢复正常行走功能;根据AOFAS踝-后足疗效评价标准评分为(94.32±4.23)分,与术前比较差异有统计学意义(P<0.05)。结论采用跟腱龙行微创有限切开经皮技术修复急性跟腱断裂安全、有效,术后患者可早期行功能锻炼。

Objective To assess the short-term effect of the mini-invasive surgical method by Achillon in repair of acute achilles tendon rupture. Methods Between December 2009 and February 2010, 11 patients （11 feet） with acute achilles tendon ruptures were treated, including 8 males （8 feet） and 3 females （3 feet） with an average age of 35.4 years （range, 23-58 years）. There were 9 cases of jump injury, 1 case of glass cut injury, and 1 case of fall injury. The results of Thompson test were positive in 11 cases （11 feet）. According to the American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot scoring system, the score was 53.19 ± 6.31. MRI indicated that the gap of the acute achilles tendon rupture was 1-5 cm （3.8 cm on average）. The interval between injury and operation was 2-7 days （3.6 days on average）. An approximately longitudinal 3-4 cm incision was performed and the ruptured achilles tendon was repaired by use of Achillon. Early rehabilitation was carried out. Results The operation time was 27-58 minutes （38 minutes on average）. The hospitalization time were 2-3 days （2.5 days on average）. Superficial wound infections occurred in 2 cases, and wound healed after dressing change; orther incision healed by first intention. All the patients were followed up 5-8 months with an average of 6.7 months. No wound problems, sural nerve injuries, or re-ruptures occurred in the other cases. After a 3-month follow-up, all patients were able to return to normal walking. The AOFAS ankle-hindfoot score was 94.32 _＋ 4.23, showing significant difference when compared with that before operation （P 〈 0.05）. Condusion The technique with Achillon offers patients a safe procedure for repair of acute achilles tendon ruptures and early active rehabilitation can be carried out.