带线铆钉联合改良阔筋膜移植治疗陈旧性跟腱断裂疗效分析

目的：观察带线铆钉联合改良阔筋膜移植治疗陈旧性跟腱断裂的临床疗效。方法采用带线铆钉联合改良阔筋膜移植修复陈旧性跟腱断裂患者31例。男22例，女9例；年龄22~52岁，平均40岁。均为单侧跟腱完全性断裂，左侧17例、右侧14例。受伤至手术时间为4~6周，平均5周。肌腱缺损2~7cm，平均5cm。术后采用Arner-Lindholm评定法评估疗效。结果手术时间60~100min，平均75min；术中出血量约80~200ml，平均100ml。2例术后第1天发现切口皮缘颜色偏白，皮肤张力高，缝线卡压形成束带，予张力最大部位拆除部分缝线，加强伤口换药处理，术后1周待皮肤松弛后在局麻下行伤口清创缝合，切口愈合无感染；其余29例均Ⅰ期愈合。所有患者防访1~2年，平均16个月，无血管神经损伤，跟腱无再断裂。按Arner-Lindhohm评定标准判定，优20例、良9例、差2例，临床优良率达93.5％。结论带线铆钉联合改良阔筋膜移植治疗陈旧性跟腱断裂，跟腱固定强度良好，术后可早期功能锻炼，可有效避免肌腱粘连，功能恢复良好。

Objective To sum up the results of the treatment of old achilles tendon rupture repaired with suture anchors and modifying fascia lata transplantation. Methods The 31 cases of old achilies tendon rupture were repaired by suture anchors with improved fascialata transplantation and followed-up.There were 22 males and 9 females with an average of 40 years old（range,22~52years）. Unilateral achilies tendon rupture was observed in all cases with left in 17 and right in 14. Injury to operating time was 4~6 weeks,an average of 5 weeks. Tendon defect gap was 2~7cm （mean 5cm）.The outcomes were evaluated by using Arner-Lindholm＆#39;s scoring system. Results The average operation time was 75 minutes（range, 60~100minutes）.The average intraoperative blood loss was 100ml（range,80~200ml）. The incision edge color with slants white skin was found in 2 cases at 1 day postoperative,the skin tension was high and stitches formed a band. Through removed part of the suture of the maximum tension parts and strengthened the treatment of the wound dressing,after 1 week,the skin became flabby. Debridement and suture of the wound was operated with local anesthesia. The incision was healed without infection.The rest of the 29 cases were stageⅠhealing. All 31 cases were followed up 1~2years,average of 16 months,no nerve vessel damage,no achilles tendon rupture again.According to Arner-Lindholm＆#39;s evaluation criteria,it was excellent in 20 cases, good in 9,poor in 2. The operation result of clinic excellent and good rate was 93.5%. Conclusion For patients with old Achilles tendon rupture, using the suture anchors and improved fascia lata transplantation can attain rigid fixation,early functional exercise,effective prevention of tendon adhesion,and good function recovery.