切口内筋膜血管丛下结合锚钉治疗新鲜闭合性跟腱断裂方法的探讨

Treatment of acute closed Achilles tendon ruptures by freeing and protecting inner fascia vascular plexus combined with rivet repair through medial incision

目的探讨切口内筋膜血管丛下结合铆钉治疗新鲜闭合性跟腱断裂方法的临床疗效。方法对48例闭合性跟腱断裂患者行跟腱内侧切口,术中显露胫后动脉穿支,游离并保护其筋膜血管丛,形成连接切口两端皮肤筋膜血管蒂桥,结合铆钉编织缝合;6周去除外固定后,进行伸展及等长收缩等训练。结果术后48例均获得随访,随访时间9个月~2年,平均12.92个月,术后按照美国足踝外科协会（American Orthopaedic Foot＆Ankle Society,AOFAS）踝与后足功能评价功能评分标准,其中优40例,良5例,可3例,优良率为93.75%（45/48）。无一例发生腓肠神经及胫神经损伤、跖部痛性瘢痕、足底内外侧神经损伤、伤口感染、裂开。结论采用跟腱内旁切口,保护筋膜血管丛,结合铆钉修复跟腱断裂手术方法治疗新鲜闭合性跟腱断裂,手术操作简便,吻合方法可靠,创伤小,皮肤坏死率低,功能恢复佳,适用于基层医院开展。

Objective To discuss the treatment method of fresh closed Achilles tendon rupture by freeing and protecting inner fascia vascular plexus and rivet repair through medial incision. Methods Forty-eight patients with rupture of Achilles tendon were applied with medial incision in Achilles tendon. During the operation,the posterior tibial artery perforator was exposed,the fascia vascular plexus was freed and protected,the vascular pedicle bridge was formed to connect skin fascia at both ends of incision,and rivets were used for braided suture. Six weeks after removing external fixation,the stretching and isometric training were conducted. Results All 48 patients were followed up for an average of 11 months（ ranging 9 months ~ 2 years）. According to American Orthopaedic Foot Ankle Society（ AOFAS） evaluation score,there were 40 excellent cases,5 good cases and 3 fair cases,and the excellent and good rate was 93. 75%（ 45 /48）. There was no case of sural nerve injury,tibial nerve injury,plantar painful scar,injury of the medial and lateral nerves,wound infection,or split. Conclusion The fresh closed Achilles tendon rupture is treated by applying medial incision in Achilles tendon,freeing and protecting inner fascia vascular plexus combined with rivet repair,which has advantages of simple operation,reliable anastomosis,minimal invasion,low skin necrosis rate and good functional recovery. It is worthy to be conducted in primary hospitals.