跟腱闭合性断裂手术修复63例临床分析

Clinical Analysis of Surgical Repair for 63 Patients with a Closed Achilles Tendon Rupture

目的对63例跟腱闭合性断裂病例手术治愈后病因分析,疗效观察,总结经验。方法对2006年7月-2011年7月年东莞市常平人民医院接诊的63例跟腱闭合性断裂病例,63例均实施了手术修复,39例采用Bunnell法缝合,两断端马尾状断缘互相交叉呈瓣结样,不整齐跟腱断端Beker法显微外科修复,24例实施双改良Kellsser法十字交叉缝合修复,马尾状断端Beker法显微外科修复。术后1～3周长腿石膏外固定,术后4～6周短腿石膏外固定,术后第7周去石膏功能训练。结果术后所有患者5～24月(平均12月)随访,其中60例踝关节活动范围正常(背屈20°～跖屈45°),3例背屈稍受限(背屈10°～跖屈45°);无跟腱与皮肤粘连。按照Ander-Lindhorm疗效判定标准,优60例(95.2%),良3例(4.8%)。优良率100%。结论采用手术方法修复闭合性跟腱断裂,术中显微外科操作,修复跟腱旁组织,术后行保护性功能训练,治疗满意。

Objective To analyze the etiology of 63 patients with a closed achilles tendon rupture, and evaluate the surgical effect. Methods From July 2006 to July 2011, our department received 63 patients with closed Achilles tendon rupture, all cases received surgical repair,39 patients was operated with Bunnell suture,24 cases with modified Kellsser suture repair. Mter surgery, the injured limb was immobilized for 1 - 3 weeks with the long leg cast, for 4 - 6 weeks with short leg cast, and functional training beginning on the 7th week. Results All patients received a follow-up of 5 -24 months（ mean 12 months）, the ankle motion range of 60 cases were normal （ dorsiflexion, 20°-plantar flexion 45 ° ）, dorsiflexion was lightly limited （ dorsiflexion 10°-plantar flexion 45 °） in 3 case;no adhesion was found between Achilles tendon and skin. With Ander-Lindhorm efficacy criteria,60 cases （95.2%） were excellent, 1 case good（4.8% ）. The fineness rate was 100%. Conclusion The surgical repair for closed Achilles tendon rupture can be applied with microsurgical operation, repairing tissue around Achilles tendon, and make the protectfunctional training after surgery, which can get satisfied clinical outcome.