小切口与常规切口端端吻合治疗新鲜跟腱断裂的疗效比较

Minimally invasive versus conventional surgical repair of fresh rupture of the achilles tendon

目的比较小切口与常规切口端端缝合治疗新鲜跟腱断裂的疗效。方法2006年3月至2009年6月分别采用常规切口和小切口治疗93例新鲜跟腱断裂患者，其中常规切口组（A组）52例，男47例，女5例；年龄23～62岁，平均44．2岁。小切口组（B组）41例，男38例，女3例；年龄22～65岁，平均42．6岁。术后应用相同的康复程序，采用临床客观检查、患者主观满意率及美国足踝外科协会（AOFAS）评分进行评价。结果A组患者术后获15～52个月（平均28个月）随访，B组患者术后获13～50个月（平均26个月）随访。A组切口表浅感染6例，深部感染1例，感染率为13．5％，B组均未发生切口感染等并发症；A组平均切口长度较B组长7．3cm；A组平均AOFAS评分为93分，B组为98分，以上指标两组比较差异均有统计学意义（P〈0．05）。跟腱与皮肤切口粘连发生率、再断裂率、踝关节活动受限发生率、患者满意率、小腿最大周径伤侧与对侧的差、跟腱断裂平面周径伤侧与对侧的差及恢复伤前活动时间两组比较差异均无统计学意义（P〉0．05）。两组患者均未产生因腓肠神经损伤导致的足背皮肤感觉障碍，无小腿深静脉血栓形成。除1例发生深部感染，其他患者均恢复伤前活动。结论应用跟腱缝合引导器及小切口微创修复新鲜腱断裂总体结果优于常规切口技术。

Objective To compare clinical and functional outcomes between conventional and minimally invasive treatment of acute rupture of the Achilles tendon. Methods From March 2006 to June 2009, 93 patients with fresh rupture of the Achilles tendon received either conventional or minimally invasive treatment in our hospital. Fifty-two patients, 47 men and 5 women, aged from 23 to 62 years （average, 44.2 years）, had a Bunnell end-to-end suture repair （group A）, while 41 patients, 38 men and 3 women, aged from 22 to 65 years （average, 42.6 years）, had a minimally invasive repair （group B）. The same functional rehabilitation protocol was adopted after surgery for both groups. Clinical and functional outcomes were evaluated and compared according to clinical check-ups, The American Orthopaedic Foot ＆ Ankle Society （AOFAS） score and rate of subjective satisfaction of the patient. Results The average follow-up period was 28 months （range, 15 to 52 months） for group A and 26 months （range, 13 to 50 months） for group B. Deep or superficial wound infection occurred in 7 cases （13.5%） in group A, but none in group B （ P = 0. 043 ）. The mean incision was 7.3 em longer in group A as compared with group B （ P = 0. 000）. The mean AOFAS score was 93 points in group A as compared with 98 points in group B（ P = 0. 026） . Differences between the 2 groups with regard to incidence of rerupture, limited joint activity, adhesion and rate of satisfaction were not significant （ P 〉 0.05 ） . No significant differences were found between the 2 groups with regard to calf and ankle circumferences and time for returned to normal sports （ P 〉 0.05） . No patient had sensory disturbance in the sural nerve distribution. All patients return to normal sports except one ease who had a deep wound infection. Conclusion Minimally invasive treatment have advantages over conventional treatment for fresh ruptures of the Achilles tendon.