微创通道辅助缝合系统结合改良Bunnel缝合法治疗急性闭合性跟腱断裂临床疗效研究

Efficacy of channel-assisted minimally invasive repair combined with modified Bunnel suture in treatment of acute closed Achilles tendon rupture

目的:探讨通道辅助缝合系统(CAMIR)微创修复术结合改良Bunnel缝合法治疗急性闭合性跟腱断裂的临床疗效。方法:选取因运动损伤导致急性闭合性跟腱断裂的21例患者为研究对象,采用CAMIR结合改良Bunnel缝合法进行治疗。记录手术时间、术中出血量、切口长度、住院时间、切口愈合情况、术后并发症、术后末次随访Arner-Lindholm疗效评分,比较术前与术后末次随访的美国矫形外科足踝协会(AOFAS)评分。结果:所有患者均获完整随访,随访12~24个月,平均(15.0±3.47)个月;手术时间30~45 min,平均(35.17±4.84)min;术中出血量20~55 ml,平均(47.78±8.08)ml;切口长度2~3 cm,平均(2.50±0.80)cm;住院时间4~7 d,平均(5.22±1.00)d;所有患者手术切口愈合良好,无切口感染、下肢静脉血栓形成、跟腱再断裂以及腓肠神经损伤等并发症;术后末次随访时,所有患者步态、跖屈及提踵力量均恢复至断裂前水平,依Arner-Lindholm疗效评分标准获得优18例,良3例,优良率100%;术前及术后末次随访AOFAS评分分别为(45.00±10.04)分和(96.48±4.30)分,两者比较存在统计学差异(P<0.05)。结论:CAMIR结合改良Bunnel缝合法治疗急性闭合性跟腱断裂与其他手术方式相比,在缩短手术及住院时间、减少创伤、降低切口感染率的基础上能够避免腓肠神经损伤,近期临床效果明显。

Objective:To explore the clinical effect of channel-assisted minimal invasive repair(CAMRI)combined with modified Bunnel suture in the treatment of acute closed Achilles tendon rupture.Methods:21 patients with acute closed Achilles tendon rupture caused by sports injury were selected as the study object,and treated with CAMIR and modified Bunnel suture.The operation time,intraoperative hemorrhage volume,incision length,hospitalization time,incision healing,postoperative complications,Arner-Lindholm score at the last follow-up after operation were recorded,and the American Orthopaedic Foot and Ankle Society(AOFAS)scores before operation and at the last follow-up after operation were compared.Results:All patients were followed up for 12 to 24 months,with an average of(15.0±3.47)months.The operation time was 30 to 45 minutes,with an average of(35.17±4.84)minutes;intraoperative hemorrhage volume was 20 to 55 ml,with an average of(47.78±8.08)ml;incision length was 2 to 3 cm,with an average of(2.50±0.80)cm;hospitalization time was 4 to 7 days,with an average of(5.22±1.00)days.There were no complications such as infection of incision,rupture of Achilles tendon,thrombosis of lower extremity vein and injury of sural nerve.At the last follow-up,the gait,plantar flexion and heel lifting strength of all patients recovered to the level before fracture.According to the Arner-Lindholm efficacy score,18 cases were excellent,3 cases were good,and the excellent and good rate was 100%.The AOFAS scores before operation and at the last follow-up after operation were 41.89±4.61 and 95.06±2.44 respectively,with statistical difference(P<0.05).Conclusion:Compared with other surgical methods,CAMIR combined with modified Bunnel suture can avoid the injury of sural nerve on the basis of shortening the time of operation and hospitalization,reducing the trauma and reducing the infection rate of incision,and has obvious clinical effect in the near future.