Kessler缝合联合富血小板血浆治疗跟腱断裂

Kessler suture combined with platelet-rich plasma in the treatment of Achilles’ tendon rupture

[目的]探讨Kessler缝合联合富血小板血浆(platelet rich plasma, PRP)治疗跟腱断裂的临床结果。[方法]回顾性分析2017年1月—2019年10月本院收治的102例跟腱断裂患者临床资料。依据术前医患沟通结果分为两组,其中50例单纯采用Kessler缝合法治疗(n-PRP组),52例采用Kessler缝合联合PRP局部注射(PRP组)。比较两组围手术期、随访与超声影像资料。[结果]两组患者手术均顺利完成,术中无神经损伤、血管损伤等并发症。两组在手术时间、切口长度、术中出血量、切口愈合和住院时间的差异均无统计学意义(P>0.05)。随访12个月以上,两组患者开始下地行走时间差异无统计学意义(P>0.05),但是,PRP组恢复完全负重活动显著早于n-PRP组[(5.31±0.67)周vs (6.97±0.75)周,P<0.05]。术后6个月和12个月,PRP组的AOFAS评分和踝跖屈-背伸ROM均显著优于n-PRP组(P<0.05)。末次随访时,PRP组的单腿跳功能显著优于n-PRP组(P<0.05)。超声影像方面,术后6、12个月,PRP组的超声影像表现均显著优于n-PRP组(P<0.05)。[结论] Kessler缝合联合PRP局部注射可显著促进跟腱愈合,改善功能。

[Objective] To explore the clinical outcomes of Kessler suture combined with platelet rich plasma(PRP) in the treatment of Achilles tendon rupture. [Method] A retrospective study was conducted on 102 patients who underwent surgical treatment for Achilles’ tendon rupture in our hospital from January 2017 to October 2019. Based on the results of preoperative doctor-patient communication, 50 patients received the tendon repairing with Kessler suture technique alone(the n-PRP group), while the remaining 52 patients had tendon repaired with Kessler suture, followed by PRP local injection(the PRP group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation done successfully with no complications such as nerve injury and vascular injury during the operation. There was no significant difference between the two groups in operation time, incision length, intraoperative blood loss, incision healing and hospitalization time(P>0.05). All the patients in both groups were followed up for more than12 months. Although there was no statistically significant difference in time to resume walking between the two groups(P>0.05), the PRP group resumed full weight-bearing activities significantly earlier than the n-PRP group [(5.31±0.67) weeks vs(6.97±0.75) weeks, P<0.05]. At 6 and 12 months after surgery, the PRP group proved significantly superior to the n-PRP group in terms of AOFAS score and ankle plantar flexion-dorsal extension range of motions(ROM)(P<0.05). At the latest follow-up, the PRP group had significantly better single-leg jump forward function than the n-PRP group(P<0.05). In terms of ultrasound imaging evaluation, the PRP group had significantly better ultrasound imaging performance than the n-PRP group at 6 and 12 months after operation(P<0.05). [Conclusion] Kessler suture combined with PRP local injection does significantly promote Achilles tendon healing and improve recovery of ankle function.