超声引导下改良Bunnell法经皮缝合术治疗急性闭合性跟腱断裂的疗效

Efficacy of ultrasound-guided modified Bunnell method percutaneous suturing in the treatment of acute closed Achilles tendon rupture

目的:比较超声引导下改良Bunnell法经皮缝合、Bunnell法经皮缝合、切开缝合三种方法治疗急性闭合性跟腱断裂的疗效。方法:按手术方式不同将90例急性闭合性跟腱断裂患者分为A、B、C三组,每组各30例。A组采用超声引导下改良Bunnell法经皮缝合,B组采用Bunnell法经皮缝合,C组采用切开缝合进行治疗。观察三组的手术时间、出血量、住院时间、疼痛程度[视觉模拟评分(VAS评分)],手术前后跟腱断端间隙、创伤指标[白细胞(WBC、C-反应蛋白(CPR)、降钙素原(PCT)的表达水平],手术相关并发症发生情况、术后恢复工作时间及恢复运动时间,末次随访按跟腱完全断裂评分标准(ATRS)及Thermann跟腱损伤评分(Thermann评分)评价踝关节的功能。结果:A、B组手术时间、出血量、住院时间、VAS评分优于C组(P<0.05);A、C组术后跟腱断端间隙小于B组(P<0.05);C组术前、术后的创伤指标变化较A、B组明显(P<0.05);术后B组并发症发生率高于A组、C组(P<0.05);A、C组术后恢复工作时间及恢复运动时间均短于B组(P<0.05)。结论:三种方法均能有效治疗急性闭合性跟腱断裂,其中超声引导下改良Bunnell法经皮缝合在保持微创优势同时,最大限度避免并发症发生,是治疗急性闭合性跟腱断裂的较理想方法。

Objective:To compare the efficacy of ultrasound-guided modified Bunnell method,Bunnell method and open suture in the treatment of acute closed Achilles tendon rupture.Methods:90 patients with acute closed achilles tendon rupture were divided into group A,B and C according to the different surgical methods,30 cases in each group.The patients in group A were treated with ultrasound-guided modified Bunnell method,Bunnell method of percutaneous suture in group B,and incision and suture in group C.The operation time,blood loss,hospital stay,pain degree(VAS score),preoperative and posterior achilles tendon gap,preoperative and postoperative trauma indexes(WBC,CPR,PCT),the occurrence of surgery-related complications,the time to resume working and exercise after operation were observed.The ankle joint function was evaluated by ATRS score and Thermann score at the last follow-up.Results:Groups A and B performed better in terms of operative time,hemorrhage,hospital stay,and VAS score than group C(P<0.05).The postoperative Achilles tendon rupture gap was significantly smaller in groups A and C than in group B(P<0.05).The changes of trauma indexes before and after surgery in group C were significantly higher than that in group A and B(P<0.05).The incidence of postoperative complications in group B was higher than that in group A and C(P<0.05).The estimated return to work and return to exercise times were shorter in groups A and C than in group B,with statistically significant difference(P<0.05).Conclusion:While all three procedures are efficient for acute closed Achilles tendon rupture,ultrasound-guided modified Bunnell method percutaneous suture is the optimum method since it minimize complications while maintaining minimally invasive benefits.