改良Giftbox缝合法联合束状捆扎技术治疗急性跟腱断裂的疗效分析

Clinical analysis of modified Giftbox suture combined with bundle binding technique in the treatment of acute Achilles tendon rupture

目的探讨改良的Giftbox缝合法联合束状捆扎技术治疗急性跟腱断裂的手术疗效。方法回顾性研究。纳入徐州市中心医院手足显微外科2016年1月—2018年12月急性跟腱断裂患者38例,其中男32例、女6例,年龄17~73(39.2±16.8)岁,左侧18例、右侧20例。均采用改良Giftbox缝合联合束状捆扎法行跟腱切开缝合术。观察患者手术前后美国矫形外科足踝协会踝-后足评分系统(AOFAS)评分的变化;末次随访时,对比患者两侧小腿周径,采用跟腱完全断裂评分系统(ATRS)进行评分,并以Amer-Lindholm评分评价手术疗效。结果本组38例患者均完成手术,术后均获随访,随访时间为(9.1±3.4)个月。末期随访时:患者AOFAS评分为(90.7±3.0)分,较术前的(45.2±4.4)分明显提高,差异有统计学意义(t=57.97,P<0.001);ATRS评分为(80.3±6.3)分;患者小腿周径患侧为(38.9±4.3)cm、健侧为(39.3±4.4)cm,两侧比较差异有统计学意义(t=-3.63,P=0.001)。按Amer-Lindholm评分评价,本组疗效优20例、良17例、差1例,优良率为97.4%(37/38)。结论利用改良Giftbox缝合法联合束状捆扎技术治疗急性跟腱断裂效果确切,跟腱长度和强度恢复良好。

Objective To evaluate the effect of modified Giftbox suture combined with bundle binding technique in treating acute Achilles tendon rupture.Methods A total of 38 patients,including 32 males and 6 females,with acute Achilles tendon rupture in XuZhou Central Hospital from January 2016 to December 2018 were studied retrospectively.The average age of the patients was 17-73(39.2±16.8)years old,and the ratio of the left and right sides was 18:20.All patients underwent the operation of Achilles tendon incision and suture with the specific operation method,that is,modified giftbox suture combined with bundle binding technique.The changes of the ankle hindfoot scoring system of American Orthopedic Foot and Ankle Association Score(AOFAS)before and after operation were observed.At the last follow-up,the peripheral diameters of both legs were compared,the Achilles tendon rupture score(ATRS)was obtained,and the surgical effect was evaluated by Amer Lindholm score.Results The operation was performed in all 38 patients and the postoperative follow-up was conducted.The follow-up time was(9.1±3.4)months.At the end of the follow-up,the AOFAS score was 90.7±3.0,which was higher than that before surgery at 45.2±4.4.The difference was statistically significant(t=57.97,P<0.001).The ATRS score was 80.3±6.3.The calf circumference of the 38 patients was(38.9±4.3)cm on the affected side and(39.3±4.4)cm on the healthy side.The difference was statistically significant between the two sides(t=-3.63,P=0.001).According to Amer-Lindholm score,20 patients scored excellent,17 patients scored good,and 1 patient scored fair,and the rate of excellent and good efficacy was 97.4%(37/38).Conclusions The modified Giftbox suture combined with bundles binding technique is effective in treating acute Achilles tendon rupture,which can restore the length and strength of the Achilles tendon.