改良经皮缝合法与开放缝合法修复新鲜闭合性跟腱断裂的疗效比较

EFFECTIVENESS COMPARISON BETWEEN MODIFIED PERCUTANEOUS SUTURE AND CONVENTIONAL OPEN SUTURE IN REPAIRING ACUTE CLOSED Achilles TENDON RUPTURE

目的通过与开放缝合法比较,探讨改良经皮缝合法修复新鲜闭合性跟腱断裂的疗效。方法 2006年1月-2009年10月,收治50例新鲜闭合性跟腱断裂患者,根据治疗方法不同分为两组,22例采用改良经皮缝合法治疗(改良组),术中于跟腱两侧平行各作5个孔,采用"之"字形方式缝合;28例采用Kesller缝合法治疗(常规组)。两组患者性别、年龄、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果常规组术后1例切口感染,1例跟腱再断裂,2例切口瘢痕挛缩;改良组患者切口均Ⅰ期愈合,无并发症发生。改良组手术时间为(38.7±6.6)min,明显短于常规组(52.3±6.9)min(t=—12.29,P=0.00);改良组术中失血量为(4.9±2.0)mL,显著低于常规组(40.7±7.1)mL(t=—25.20,P=0.00)。两组患者均获随访,随访时间2～3年,平均29.9个月。术后2年应用美国矫形足踝协会(AOFAS)评分标准评定,改良组为(99.6±1.0)分,常规组为(98.4±3.0)分,差异无统计学意义(t=1.66,P=0.10)。结论与开放缝合法比较,改良经皮缝合法具有手术操作简便、并发症少、踝关节功能恢复快等优点,是治疗新鲜闭合性跟腱断裂的较好选择之一。

Objective To investigate the e ectiveness of modi ed percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture.Methods Between January 2006 and October 2009,50 patients with acute closed Achilles tendon rupture were treated with modi ed percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture（improved group,n=22） and with Kessler suture（conventional group,n=28）,respectively.No signi cant di erence was found in gender,age,time from injury to operation between 2 groups（P 0.05）.Results In improved group,the patients achieved healing of incisions by rst intention after operation and no complication occurred;however,incision infection occurred in 1 case,Achilles tendon re-rupture in 1 case,and incision scar contracture in 2 cases in conventional group.The operation time of improved group [（38.7 ± 6.6） minutes] was signi cantly shorter（t=—12.29,P=0.00） than that of conventional group [（52.3 ± 6.9） minutes];the blood loss of improved group [（4.9 ± 2.0） mL] was significantly less（t= —25.20,P=0.00） than that of conventional group [（40.7 ± 7.1） mL].The patients were followed up 2-3 years（mean,29.9 months）.The American Orthopaedic Foot and Ankle Society（AOFAS） score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group,showing no signi cant di erence between 2 groups（t=1.66,P=0.10）.Conclusion Comparison with conventional open suture,modi ed percutaneous suture has some advantages,such as easy operation,less complications,rapid recovery of limb function,and so on.Modi ed percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.