手术与非手术治疗急性跟腱断裂的对比研究

Comparative study on surgical and non-surgical treatment of acute Achilles tendon rupture

目的探讨手术与非手术治疗跟腱断裂的临床疗效。方法回顾分析解放军联勤保障部队第九〇四医院2011年1月~2017年10月分别采用手术和非手术治疗74例跟腱断裂患者临床资料。其中手术(非老年)组43例,男28例,女15例;非手术(老年)组31例,男18例,女13例。观察两组跟腱再断裂例数、高风险并发症(手术切口慢性窦道形成需再次手术、切口感染、下肢深静脉血栓形成甚至引起肺栓塞等)、低风险并发症(切口延迟愈合、肉芽肿形成、皮肤跟腱粘连、腓肠神经损伤);回到原工作岗位时间及该时间视觉模拟疼痛(VAS)评分;末次随访踝关节活动受限例数;评定两组末次随访Arner-Lindholm疗效优良率。结果74例患者均获随访,随访时间12~24个月,平均15个月。其中手术组2例、非手术组7例发生跟腱再次断裂(P=0.014);手术组6例、非手术组0例发生高风险并发症(P=0.030);手术组11例、非手术组6例发生低风险并发症(P=0.530);但两组总体并发症比较,差异无统计学意义(P=0.064);手术组平均7.7周、非手术组平均11.2周回到工作岗位(P=0.000);该时间段两组VAS评分比较,差异有统计学意义(P<0.05);手术组7例、非手术组8例患者踝关节活动受限,但不影响患者日常生活(P=0.314);两组末次随访Arner-Lindholm疗效评定优良率比较,差异无统计学意义(P=0.675)。结论手术治疗可以明显降低跟腱再断裂率,但同时也有出现高并发症的风险;手术治疗可以使患者早期回到工作岗位,故手术治疗比较适用对生活质量及运动要求较高的患者,但对于老年人及对日常活动要求较低的低运动量患者,非手术治疗同样可以获得较为满意的疗效,不失为一种较好的选择。

Objective To explore the clinical efficacy of surgical and non-surgical treatment of Achilles tendon rupture.Methods The clinical data of 74 patients with Achilles tendon rupture treated by surgical and non-surgical treatment from January 2011 to October 2017 in the No.904 Hospital of the PLA Joint Logistics Support Force were retrospectively analyzed.Among them,the surgical(non-elderly)group had 43 cases including 28 males and 15 females;the non-surgical(elderly)group had 31 cases including 18 males and 13 females.Observation indicators consisted of the number of rerupture of the Achilles tendon,high-risk complications(reoperation for chronic sinus formation of surgical incision,incision infection,deep vein thrombosis of the lower extremity and even cause pulmonary embolism,etc.),low-risk complications(delayed healing of the incision,granulation swelling,skin and Achilles tendon adhesion,sural nerve injury);time to return to the original work position and the VAS(Visual Simulated Pain)score at that time;the number of patients with limited ankle movement at the last follow-up;Arner-Lindholm excellent and good rate assessment at the last follow-up of the two groups.Results All 74 patients were followed up for 12-24 months,with an average of 15 months.Among them,2 cases in the operation group and 7 cases in the non-operation group had re-rupture of the Achilles tendon(P=0.014);6 cases in the operation group and 0 case in the non-operation group had high-risk complications(P=0.030);11 cases in the operation group and 6 patients in the non-operation group had low-risk complications(P=0.530).But there was no statistically significant difference in the overall complications between the two groups(P=0.064).It took 7.7 weeks in the operation group and 11.2 weeks in the non-operation group averagely to return to work(P=0.000).The difference in VAS scores between the two groups was statistically significant(P<0.05).7 patients in the surgery group and 8 patients in the non-surgery group had limited ankle movement,but did not affect the patients'daily life(P=0.314).There was no statistically significant difference in the evaluation of the excellent and good rate of Lindholm efficacy evaluation(P=0.675).Conclusion Surgical treatment can significantly reduce the rate of Achilles tendon rerupture,but at the same time it has a high risk of complications.Surgical treatment can return patients to work early,so it is more suitable for patients with higher quality of life and exercise.However,for the elderly and low physical activity patients with low requirements for daily activities,non-surgical treatment can also obtain more satisfactory results,which is a good choice.