经皮微创缝合与传统手术治疗急性跟腱断裂的临床疗效比较

Comparison of the clinical effect of percutaneous minimally invasive suture and traditional operation in the treatment of acute Achilles tendon rupture

目的对比传统后内侧切口手术与经皮微创缝合法治疗急性跟腱断裂的临床疗效。方法回顾分析2014年1月—2018年6月在新疆医科大学附属哈密市中心医院手术治疗的45例急性跟腱断裂患者的临床资料,按其手术方式分为传统后内侧切口组(n=23)和经皮微创缝合组(n=22)。比较两组患者的手术时间、术中出血量、术后切口并发症、平均住院时间、踝关节活动度及提踵实验阳性率,术后1年采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分方法对其功能进行疗效分析。结果传统后内侧切口组手术时间(64.13±15.25)min,术中出血量(35.17±13.26)ml,术后2例出现切口不愈合致跟腱外露,平均住院时间(15.17±1.83)d,踝关节活动度(36.4±7.35)°,术前提踵阳性率87%,术后4.3%。经皮微创缝合组手术时间(27.22±13.20)min,术中出血量(8.63±5.24)ml,切口全部一期愈合,2例出现腓肠神经损伤,平均住院时间(6.59±0.72)d,踝关节活动度(42.3±5.12)°,术前提踵阳性率91.2%,术后4.5%。两组手术时间、术中出血量、术后切口并发症、踝关节活动度及平均住院时间比较,差异有统计学意义(P<0.05)。术后1年经皮微创缝合组AOFAS踝与后足评分为(93.2±4.73)分,传统后内侧切口组为(92.6±5.62)分,两组比较,差异无统计学意义(P>0.05)。结论传统手术与经皮缝合微创治疗法均是急性跟腱断裂的有效手术治疗方法,但经皮缝合微创治疗急性跟腱断裂可明显缩短手术时间,减少术中出血,降低术后切口并发症,缩短平均住院时间,有利于患者的后期恢复。

Objective To compare the clinical efficacy of traditional posteromedial approach and percutaneous minimally invasive suture in the treatment of acute Achilles tendon rupture.Methods 45 patients of Achilles tendon rupture in our hospital were retrospectively analyzed from January 2014 to June 2018,According the operative method,we divided the patient into two groups:traditional posteromedial approach group(n=23)and percutaneous minimally invasive suture group(n=22).The operation time,intraoperative hemorrhage,postoperative incision complications,average hospitalization time,ankle joint activity and positive rate of heel lifting test were compared between the two groups.The functional outcomes were analyzed by AOFAS ankle and hind foot score at one year after operation.Results In the traditional posterior medial incision group,the operation time was(64.13±15.25)min,the intraoperative bleeding volume was(35.17±13.26)ml,and the Achilles tendon was exposed in 2 cases after operation.The average hospitalization time was(15.17±1.83)days,the ankle joint mobility was(36.4±7.35)°and the positive rate of heel was 87%before operation and 4.3%after operation.In the group of percutaneous minimally invasive suture,the operation time was(27.22±13.20)min,the intraoperative bleeding volume was(8.63±5.24)ml,the incision healed in one stage,the average hospitalization time was(6.59±0.72)days,the ankle joint activity was(42.3±5.12)°and the positive rate of heel was 91.2%and 4.5%respectively.There were significant differences between the two groups in operation time,intraoperative bleeding,postoperative incision complications,ankle joint activity and average hospitalization time.The AOFAS scores of ankle and hind foot were(93.2±4.73)and(92.6±5.62)in the group of percutaneous minimally invasive suture and the group of traditional posterior medial incision one year after operation.There was no significant difference between the two groups(P>0.05).Conclusion Traditional operation and minimally invasive percutaneous suture are both effective methods for the treatment of acute Achilles tendon rupture,but minimally invasive percutaneous suture can significantly shorten the operation time,reduce intraoperative bleeding,reduce postoperative incision complications and shorten the average hospital stay.It is beneficial to the later recovery of patients.