应用双津下缝合法修复跟腱断裂疗效分析

EFFECTIVENESS OF A DOUBLE-TSUGE SUTURE METHOD IN REPAIRING Achilles TENDON RUPTURES

目的探讨采用0号可吸收普迪思圈套线(PDS-Ⅱ线)双津下缝合法修复跟腱断裂的临床疗效。方法 2005年1月-2008年12月,收治36例跟腱断裂患者。男29例,女7例;年龄21～50岁,平均36岁。运动损伤25例,摔伤4例,锐器割伤6例,其他伤1例。新鲜闭合损伤22例,新鲜开放损伤6例,伤后至入院时间1～10 d,平均6 d;陈旧性闭合损伤8例,伤后至入院时间43～63 d,平均51 d。提踵试验及Thopmson征均呈阳性。患者均采用0号可吸收PDS-Ⅱ线双津下缝合法修复。术后于踝跖屈30°位短腿石膏固定6周后,开始功能锻炼。结果术后2例陈旧性跟腱断裂患者切口愈合不良,经对症治疗后切口愈合;其余切口均Ⅰ期愈合。患者均获随访,随访时间12～24个月,平均15个月。随访期间均未发生跟腱再次断裂及反射性交感神经营养不良。患者踝关节活动度与健侧相比,7例无减少,16例减少1～10°,12例减少10～20°,1例减少25°。根据Termann跟腱损伤临床评价标准,评分为74～96分,平均90分;获优24例,良11例,可1例,优良率为97.2%。结论双津下缝合法手术操作简便,缝线在腱内无横行交叉,修复断裂跟腱后对其血运影响小。PDS-Ⅱ线可提供高强度张力,并可完全吸收,不易发生局部粘连。采用该方法修复跟腱断裂术后并发症发生率较低,可获得较好疗效。

Objective To investigate the effectiveness of a double-tsuge suture method with absorbable polydioxanone-cord（PDS-II） in repair of Achilles tendon ruptures.Methods Between January 2005 and December 2008,36 patients suffering from Achilles tendon ruptures were treated operatively.Of 36 patients,there were 29 males and 7 females with a mean age of 36 years（range,21-50 years）,including 22 cases of acute closed injuries,6 cases of fresh open injuries（the time between injury and hospitalization was 1-10 days,mean 6 days）,and 8 cases of old closed injuries（the time between injury and hospitalization was 43-63 days,mean 51 days）.The injury reasons were sport injury（25 cases）,incised injury（6 cases）,falling injury（4 cases）,and other（1 case）.The results of ＂heel test＂ and the Thompson sign were positive in all patients.Operation was performed by using a double-tsuge suture method with a No.0 PDS-II.After the ankle joint was fixed with short leg plaster cast at 30° plantar flexion position for 6 weeks,the cast was removed and then functional exercises were done.Results Poor healing of incision occurred in 2 cases of old Achilles tendon ruptures and was cured after symptomatic treatment;healing of incision by first intention was achieved in the others.The patients were followed up 12 to 24 months（mean,15 months）.No rerupture,deep venous thromboembolism,or reflex sympathetic dystrophy occurred during follow-up.When compared with the range of motion of ankle joint of normal side,7 cases had no change,16 cases had a loss of 1-10°,12 cases had a loss of 10-20°,and 1 case had a loss of 25°.The average score was 90（range,74-96） according to Termann clinical evaluation criterion;the results were excellent in 24 cases,good in 11 cases,and fair in 1 case,and the excellent and good rate was 97.2%.Conclusion The double-tsuge suture method is easy-to-operate,which has the smallest interference to the blood supply of Achilles tendon because of no crossing or transversal intratendon suture.PDS-II can provide highly strong stability,furthermore,it can be degenerated completely with tiny foreign body reaction,so there is no tendency to develope local adhesion.This technique achieves good results and is associated with a low morbidity of complications.