改良五切口法治疗新鲜闭合跟腱断裂15例

Improved Five-Incision Method for Freshly Closed Achilles Tendon Rupture of 15 Cases

目的:分析改良五切口法治疗新鲜闭合跟腱断裂的临床疗效。方法:选取急性闭合性跟腱断裂患者15例,所有患者均行改良五切口法缝合。术后予小腿背侧石膏托固定踝关节于轻度跖屈位,3周拆除背侧石膏托更换跖侧中立位石膏托3周,6周后拆除石膏配合中药熏洗进行逐渐增加活动度锻炼及负重锻炼,8~10周完全负重行走,10~12周时可开始单踵站立,继续增加推进力量练习。结果:术后患者切口均I期愈合,无粘连,术后无感染、下肢深静脉血栓形成、腓肠神经损伤等并发症发生。所有患者均获随访,根据Termann跟腱损伤的临床评价标准,本组患者优13例,良2例。结论:采用改良五切口法修复急性跟腱断裂,伤口感染、皮肤坏死等并发症发生率低,切口小,且横行瘢痕外观不明显,临床疗效满意,而且费用低廉,患者满意度高,是一种值得推广的跟腱手术方法。

Objective:To analyze the clinical efficacy of modified five-incision method in the treatment of freshly closed achilles tendon rupture.Methods:15 patients with acute closed Achilles tendon rupture were selected, and all patients were sutured with modified five incision method.Postoperatively, the ankle joint was fixed in a mild plantar flexion by the dorsal cast of the lower leg.The dorsal cast was removed for 3 weeks and the plantar neutral cast was replaced for 3 weeks.The plaster was removed, and traditional Chinese medicine fumigation was performed after 6 weeks.Gradually increased range and heavy bearing exercise were carried out with full load walk at the 8 to 10 weeks and stand on one heel at the 10 to 12 weeks.Propulsion strength exercise was subsequently carried out.Results:All incisions healed by first intention after the operation without adhesions and complications such as postoperative infection, deep vein thrombosis of lower limbs and sural nerve injury.All patients were followed up.According to the clinical evaluation criteria of Termann achilles tendon injury, 13 cases were excellent and 2 cases were good.Conclusion:The modified five-incision method is a satisfied way to repair acute Achilles tendon rupture with low incidence of complications like wound infection and skin necrosis, small incision, not obvious transverse scar, low cost and high satisfied efficacy.Thus, it is a method worth promoting for Achilles tendon surgery.