中西医结合经皮缝合术治疗急性闭合性跟腱断裂临床疗效分析

Curative Analysis of Applying Integrative Medicine and Percutaneous Suture to Treat Acute Achilles Tendon Rupture

目的：通过对长期疗效和并发症的观察,介绍并评价中西医结合经皮缝合术治疗急性闭合性跟腱断裂临床应用上的优劣势以及疗效评估。方法：回顾性研究我院在2002年3月~2009年6月期间收治急性闭合性跟腱断裂患者,经查体以及超声、MRI诊断明确,其中通过中西医结合经皮缝合急性闭合性跟腱162例,其中男134例,女28例;年龄21~63岁,平均年龄37.3岁。记录其性别、年龄、职业、受伤运动方式及手术时间、住院时间、并发症及功能恢复情况等数据。术后常规随访,并应用Arner-Lindholm疗效评定标准对术后效果进行评定,对所有数据运用SPSS 16.0进行统计与分析。结果：其中154例获随访,随访时间2~7年,平均为3.4±0.7年。手术切口均I期愈合。手术时间为：36.4±7.8分钟,住院天数为：6.5±0.5天,患侧再次断裂为2例（1.2%）,对侧跟腱断裂为8例（2.3%）,合并腓肠神经损伤0人（0%）,按Arner-Lindholm疗效评定标准：优136例,良16例,中：2例：差：0例,优良率为98.8%;总体平均得分95.0,其中随访2年内：92.4,随访2~4年：96.6,随访4年以上：97.7.患侧提踵肌力为（4.71±1.8）级,与健侧（4.81±1.4）级比较差异无统计学意义（P〉0.05）;患侧踝关节最大跖屈角（36.7±3.2）°、背伸角（18.2±2.4）°,与健侧最大跖屈角（38.4±4.1）°、背伸角（18.1±1.7）°级比较差异均无统计学意义（P〉0.05）。结论：中西医结合经皮缝合术治疗急性闭合性跟腱断裂具有具有手术时间短,手术创伤小,无腓肠神经损伤、再断裂等经皮术式所特有的并发症出现、中后期功能恢复良好的特点。

Objective： To evaluate the clinical effects of the cooperation of Chinese and western medicine with percutanous suture on treating acute achilles tendon rupture. Methods： 162 cases were treated by the cooperation of Chinese and western med- icine with percutanous suture of acute achilles tendon rupture from 2002 to 2009, the duration of follow up ranged from 2 years to7 years. The treatment out-come were evaluated by Arner-Lindholm evaluation system. Results： All incisions healed by first intention. 154 cases were followed up 2 to 7 years and with an average of 3. 4 years. No sural nerve injury or re-rupture of aehil les tendon or deep infection occurred during follow-up period. At last follow-up, according to evaluation of curative effects by Arner-Lindholm standard, the results were excellent in 136 cases and good in 16 cases with an excellent and good rate of 98. 8%. Conclusion： The cooperation of Chinese and western medicine with percutanous is a safe and effective method with avulsion -type control ability, tensile strength, little effect on the blood supply of the achilles tendon for repairing acute avulsion-type a- chilles tendon rupture.