经皮与开放缝合治疗急性闭合性跟腱断裂的临床研究

Percutaneous versus open suture in treatment of acute achilles tendon rupture

[目的]比较经皮闭合缝合与开放缝合治疗急性闭合性跟腱断裂的疗效,为临床医生选择治疗方法提供依据。[方法]共40例患者纳入研究,随机分成两组,经皮组及开放组各20例,记录两组手术时间、住院时间、切口愈合情况、腓肠神经支配区感觉情况;3、6个月时单足提踵结果;6个月时测量小腿最大周径与跟腱断裂平面小腿周径,并计算与健侧的差值,有无跟腱黏连及再断裂,应用ATRS评分进行功能评价。[结果]两组病例均获得随访,且开放组(平均16个月)与经皮组(平均15个月)随访时间差异无统计学意义。经皮组住院时间(中位数7 d)、手术时间(中位数30 min)、总并发症发生率(5%)均低于开放组,开放组分别为12 d、60 min和40%,经皮组跟腱断裂平面小腿周径健侧与患侧差值(9.0±2.0)mm,大于开放组(7.1±1.7)mm,且上述差异有统计学意义。开放组切口并发症发生率(20%)、再断裂率(10%)、跟腱黏连发生率(10%)、3个月时单足提踵试验阳性率(40%)均高于经皮组,经皮组分别为0、0、0和35%,经皮组腓肠神经损伤率(5%)、ATRS评分(88.6±4.8)分、小腿最大周径健侧与患侧差值(8.1±2.3)mm,均大于开放组,开放组分别为0、(86.0±7.0)分、(7.5±2.2)mm,但上述差异无统计学意义。按3个月时单足提踵试验结果分组,阳性15例,ATRS评分为(86±7)分;阴性25例,ATRS评分为(90.9±3.2)分,阴性组ATRS评分更高,且差异有统计学意义。[结论]经皮闭合缝合治疗急性跟腱断裂与传统开放手术相比,可以获得同样的功能结果,且能明显缩短住院时间、手术时间及降低总并发症发生率。跟腱修复术后3个月时,单足提踵试验阴性比阳性者功能结果更好。

[Objective]To compare the efficacy of percutaneous versus open surgical treatment in acute closed achilles tendon rupture. [Method]A total of 40 patients were enrolled in the study and randomly divided into the percutaneous group and open group,with 20 patients in each. The operative time,hospital stay,wound healing,sural nerve region feeling were recorded.A single-heel-rise test was carried out and the results were recorded at three and six month postoperatively. The maximum circumference of the crus was measured at 6 month postoperatively and the difference with contralateral was calculated. Meanwhile,complications were observed,including with or without tendon adhesions and re- rupture. ATRS（ achilles tendon total rupture score） was used for functional assessment. [Result]Patients in both two groups received follow-up,and the follow-up time between two groups（ mean 16 months in open group,mean 15 months in percutaneous group） had no significant difference. The hospitalization time（ median 7 days）,operative time（ median 30 minutes）,the total complication rate（ 5%） in percutaneous group were lower than those in the open group（ 12 days,60 minutes and 40% respectively）. The contralateral and ipsilateral crus circumference in percutaneous group（ 9. 0 ± 2.0） mm was larger than that of the open group（ 7. 1 ± 1. 7）mm,and the difference was statistically significant. The incision complication rate（ 20%）,the re- rupture rate（ 10%）,the incidence of achilles tendon adhesions（ 10%）,single foot toes test positive rate at 3 months（ 40%） were higher than those in percutaneous group（ 0,0,0 and 35%,respectively）. The sural nerve injury rate（ 5%）,ATRS score（ 88. 6 ± 4. 8） and the difference of maximum contralateral and ipsilateral circumference（ 8. 1 ± 2. 3） mm were higher than those in the open group（ 0,86. 0 ± 7. 0 points,7. 5 mm ± 2. 2 mm）,but the difference was not statistically significant. According to positive result of single heel-rise test at 3 months after surgery,15 cases showed positive results,with the ATRS score of 86 ± 7 points,negative results were noted in 25 cases,with the ATRS score of 90. 9 ± 3. 2 points,ATRS score in the negative group was higher,and the difference was statistically significant. [Conclusion]Compared with traditional open surgery,percutaneous closure suture treatment for acute achilles tendon rupture can get the same functionality result,but significantly shortening the hospital stay,operation time and reducing the total complication rate. Furthermore,three months after suturing achilles tendon,a better function result could be achieved in negative single heel- rise test results than positive ones.