跟腱断裂开放修补术后最佳外固定时间的对照研究

A control study:The best option for duration of immobilization after Achilles tendon rupture repair by open surgery

目的探讨开放性手术修复跟腱断裂的术后最佳外固定时间。方法回顾性分析2017年1月—2019年6月北京大学第三医院收治的254例急性跟腱断裂患者,按照术后外固定时间0、2、4、6周分为A、B、C、D四组。所有患者均采用相同的缝合技术及康复方案,记录患者手术时间;比较各组患者踝关节活动度恢复,单足提踵恢复以及轻度运动恢复时间,以及术后2、4、6、8、10、12、14、16、24和48周的足部功能和并发症发生情况;同时采用视觉模拟疼痛评分量表(vsual analoge scales,VAS)、美国足踝骨科学会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分量表和跟腱断裂总评分(achilles tendon total rupture score,ATRS)进行功能评价。最终随访时间为平均术后22.3个月。结果各组VAS评分随时间推移明显下降,12周后各组VAS评分均为0;各组AOFAS踝-后足评分和ATRS评分在2~12周(P<0.001)和2~16周(P<0.001)的差异有统计学意义。B组各项评分均值均优于其他组,差异有统计学意义(P<0.05)。A、B两组在轻度运动、关节活动度以及单足提踵的恢复时间上明显快于C、D组(P<0.001)。并发症13例,其中浅表感染5例,深静脉血栓形成3例,跟腱外伤性再断裂5例,组间差异无统计学意义(P>0.05)。结论跟腱断裂开放修补术后2周拆除外固定,并让患者逐步开始关节功能训练,既可以让患者获得更好的功能,又不会增加术后并发症的发生。

Objective To determine the best option for duration of immobilization after achilles tendon rupture repair by open surgery.Methods From January 2017 to June 2019,254 patients with Peking University Third Hospital were divided into groups A,B,C and D according to immobilization duration of 0,2,4 and 6 weeks,respectively.All patients underwent the same suture technique with a similar rehabilitation protocol.Operation time was collected.All patients examined clinically at 2,4,6,8,10,12,14,16,24,48 with final follow-up at 22.3 mean months postoperatively.The outcomes included the time of return to light sports activity,full range of motion of ankle and single-legged heel rising and complications.VAS(visual analogue pain scale),AOFAS(American Orthopaedic Foot and Ankle Society hindfoot score),and ATRS(Achilles tendon Total Rupture score)were used for functional assessment.Results VAS scores decreased significantly,reaching 0 in all groups after 12 weeks.The AOFAS and ATRS scores were significantly different between the groups(P<0.001).All the mean scores showed better results in group B than other groups(P<0.05).In terms of recovery time of return to light sports activity,range of motion and single-legged heel rise height,groups A and B were significantly faster than groups C and D(P<0.001).There were 13 complications that occurred in this series that included 5 superficial infections,3 deep venous thrombosis and 5 reruptures.There were no significant differences in complications between the group.Conclusion Removal of immobilization 2 weeks after achilles tendon rupture repair by open surgery and gradual initiation of joint function training,which allow patients to achieve better function without increasing the incidence of postoperative complications.