微创无结桥接技术治疗急性跟腱断裂的疗效分析

Analysis of clinical effect of mini-invasive knotless bridge-suture technique for acute achilles tendon rupture

目的探讨微创无结桥接技术治疗急性跟腱断裂的疗效。方法回顾性分析2017年8月—2018年2月上海交通大学附属第六人民医院骨科收治的23例急性跟腱断裂患者的病例资料,其中男性21例,女性2例;年龄(37.1±5.6)岁,年龄范围29~51岁。所有患者均待软组织肿胀消退后行微创无结桥接技术治疗。术后3周、6周、3个月、6个月采用门诊复诊方式对患者进行随访,之后每隔3个月随访1次,随访时间为12~18个月,截止时间为2019年4月。记录患侧末次随访小腿周胫占健侧小腿的比例、1min内患肢所能完成的单腿提踵次数、美国骨科足踝外科协会(AOFAS)踝-后足评分、跟腱断裂总评分(ATRS)以及术后返回工作的时间,观察随访期间的并发症发生情况。结果23例患者均获最终随访。末次随访时患侧小腿周胫占健侧小腿的比例为(92.7±1.8)%、1min内患肢所能完成的单腿提踵次数为(25±2)次、AOFAS踝-后足评分为(91.5±2.2)分、ATRS为(92.6±2.4)分、返回工作时间为6~9周。所有患者切口均Ⅰ期愈合,无皮肤坏死、浅表感染、深部感染、腓肠神经支配区域的皮肤感觉异常等并发症,末次随访时所有患者均未见跟腱再次断裂。结论微创无结桥接技术治疗急性跟腱断裂手术操作简单,创伤小,可使患者早期复工,是安全、有效的治疗方法。

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture. Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from August 2017 to February 2018 were analyzed retrospectively. There were 21 males and 2 females, aged (37.1±5.6) years, with an age range of 29-51 years. Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved. Patients were followed up by outpatient review at 3 weeks, 6 weeks, 3rd, and 6th months postoperatively, followed by every 3 months, followed up 12 to 18 months, and the deadline was April 2019. Ratio of perimeter of the affected lower extremity to that of the uninjuried, number of repetitions for one leg calf rise in one minute, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during the follow-up period. Results Twenty-three cases were followed up. At last follow-up, ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7±1.8)%, number of repetitions for one leg calf rise in one minute was (25±2) times, AOFAS ankle-hind foot score was (91.5±2.2) scores, ATRS was (92.6±2.4) scores, time to return to work ranged from 6 to 9 weeks. All patients underwent first-stage healing. No skin necrosis, superficial infection and sural nerve injury occurred. No achilles tendon re-rupture was seen during the follow-up period. Conclusion Minimally invasive knotless bridge-suture technique for acute achilles tendon rupture is applied easily and less invasive, enabling patients to return to work earlier and proved to be a secure and effective treatment.