卵圆钳穿针微创缝合技术与常规切开缝合技术治疗急性闭合性跟腱断裂的比较研究

Comparison of minimally invasive suturing with oval forceps and conventional open suturing for acute closed Achilles tendon rupture

目的比较卵圆钳穿针微创缝合技术与常规切开缝合技术两种方法治疗急性闭合性跟腱断裂的临床疗效。方法收集急性闭合性跟腱断裂患者34例,其中2014年6月至2016年2月收治的17例患者采用常规切开缝合技术(开放组),2016年3月至2017年12月收治的17例患者采用卵圆钳穿针微创缝合技术(微创组)。比较两组患者手术时间、切口长度、住院时间、并发症发生情况和再次断裂发生情况、随访6个月后的美国足踝外科协会(AOFAS)踝-后足功能评分、患侧小腿周径减少值。结果所有患者术后随访6~10(7.5±1)个月。微创组患者手术时间少于开放组,切口长度短于开放组,两组比较差异均有统计学意义(均P<0.01);但两组患者住院时间、AOFAS评分和患侧小腿周径减少值比较差异均无统计学意义(均P>0.05)。微创组有1例跟腱再次断裂;开放组有2例伤口延迟愈合,1例跟腱再次断裂。两组患者均未发生腓肠神经损伤。结论与常规切开缝合技术相比,卵圆钳穿针微创缝合技术治疗急性闭合性跟腱断裂操作简便,手术时间短,微创伤口并发症少,且短期疗效优良。

Objective To compare minimally invasive suturing with oval forceps and conventional open suturing for acute closed Achilles tendon rupture. Methods Between June 2014 and December 2017, 34 patients with acute closed Achilles tendon rupture were enrolled in this study.Seventeen of them received minimally invasive suturing with oval forceps while other 17 patients with conventional open suturing. The operative time,incisive length, hospitalization time, complications, the American Orthopedic Foot an Ankle Society(AOFAS) ankle-hindfoot score after 6-month follow-up and the decrease in circumference of affected leg were compared between the two groups. Results The average follow-up period was6~10(7.5±1) months. The minimally invasive suture group had significantly shorter operative time and incisive length than those of conventional open suture group(both P <0.05). There were no significant differences in hospitalization time, AOFAS ankle-hindfoot score and the decrease in leg circumference between two groups. The minimally invasive suture group had one re-rupture case. Two cases of delayed wound healing and one case of re-ruptured Achilles tendon were observed in the conventional open suture group. No sural nerve lesion case was observed in two groups. Conclusion In the treatment of acute closed Achilles tendon rupture, compared with conventional open suturing, minimally invasive suturing with oval forceps may be relatively easier, and it has advantages of shorter surgery time, shorter incisive length, lower rates of complications and better short-term efficacy.