小切口内双津下缝合法修复急性跟腱断裂疗效分析

Therapeutic effects of small incisional double-tsuge suture method for repairing acute achilles tendon rupture

目的分析小切口内应用0—0可吸收普迪思圈套线（PDS—Ⅱ线）双津下缝合法修复急性跟腱断裂的临床疗效。方法本组34例患者均为急性闭合性跟腱断裂，其中男25例，女9例；年龄20—45岁，平均32岁。致伤原因：运动损伤27例，摔伤6例，重物击伤1例。受伤至手术时间1～6d，平均3d。所有患者均行微创小切口，应用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周后拆除石膏开始功能锻炼，8—10周后可完全负重，3～4个月后逐渐恢复运动。结果术后发生切口愈合不良1例，反射性交感神经营养不良1例，其余患者切口均I期愈合，无皮肤粘连。术后无感染、下肢深静脉血栓形成、腓肠神经损伤等并发症发生。所有患者均获随访，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等并发症。根据Termann跟腱损伤的临床评价标准，本组评分平均为92分（76～96分）。其中优28例，良5例，可1例，优良率为97％。结论采用小切口内双津下缝合法修复急性跟腱断裂，并发症发生率低，临床疗效满意，是一种理想的跟腱手术方法。

Objective To evaluate the efficacy of mini-incisional double-tsuge suture method with 0-0 absorbable polydioxanone-eord （PDS-H） in repair of acute achilles tendon rupture. Methods A total of 34 patients were subjected to acute closed achilles tendon ruptures, including 25 at a mean age of 32 years （range, 20-45 years）. Injury causes included sports injumales and 9 females ries in 27 patients, falling injuries in six and heavy object impingement injury in one. The time from injury to operation was average 3 days （range, 1-6 days）. All patients underwent minimally invasive repair with double-tsuge suture method by using PDS-II. The ankle joint was fixed with short leg plaster cast at 30° plantar flexion position and the cast was removed six weeks later to take functional exercise. The patients could walk with full weight-bearing 8-10 weeks later and could gradually return to activity 3-4 months later. Results There was one patient with poor incision healing and one patient with reflex sympathetic dystrophy postoperatively. The rest patients had stage [ incision healing without skin adhe- sions. No complications such as infection, lower extremity deep venous thrombosis or sural nerve injury occurred postoperatively. All the patients received follow-up of 12-24 months （ average 15 months ）, which showed no complications like tendon rerupture occurred. According to clinical evaluation criterion of Termann, the average score was 92 points （range, 76-96 points）. The result was excellent in 28 patients, good in five and fair in one, with excellence rate of 97%, Conclusions Small incisional double-tsuge suture method achieves low rate of complications and good outcomes for repairing acute achilles tendon rupture and is an ideal tendon surgery approach.