经皮经跟骨止点重建治疗急性跟腱止点撕脱

Application of percutaneous transcalcaneal reconstruction technique for acute Achilles tendon insertion avulsion

目的 探讨经皮经跟骨止点重建治疗急性跟腱止点撕脱疗效。方法 2014年1月—2020年6月,采用经皮经跟骨止点重建治疗25例急性跟腱止点撕脱患者。其中,男24例,女1例;年龄34-60岁,平均44.1岁。病程1-5 d,平均1.8 d。致伤原因:运动伤23例,摔伤2例。术前美国矫形足踝协会(AOFAS)踝与后足功能评分为(55.6±6.7)分,疼痛视觉模拟评分(VAS)为(4.6±0.5)分。记录手术时间、术中出血量、住院时间、切口愈合情况,术后患者开始垫跟负重站立、垫跟行走时间,以及并发症发生情况。彩色多普勒超声检查跟腱连续性,MRI检查跟腱愈合情况。采用VAS评分、AOFAS踝与后足功能评分评价踝关节疼痛及功能,ArnerLindholm疗效评定标准评价疗效。结果 手术时间45-50 min,平均46.8 min;术中出血量10-20 mL,平均13.8 mL;住院时间4-6 d,平均4.9 d。出院前复查彩色多普勒超声提示跟腱连续性恢复。术后切口均Ⅰ期愈合,无腓肠神经损伤、下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间15-50个月,平均30.3个月。术后14-21 d开始垫跟负重站立,平均17.6 d;20-28 d开始垫跟行走,平均23.7 d。末次随访时MRI复查示跟腱均达腱性愈合。AOFAS踝与后足功能评分术后6个月为(90.0±3.2)分、末次随访时为(95.8±4.5)分,VAS评分分别为(1.7±0.6)、(1.0±0.8)分,均较术前改善(P<0.05);术后两时间点间比较,差异亦有统计学意义(P<0.05)。末次随访时,根据Arner-Lindholm疗效评定标准评价均达优;患者均恢复体育运动。结论 经皮经跟骨止点重建治疗急性跟腱止点撕脱并发症较少,术后患者恢复较快,踝关节功能恢复较好。

Objective To introduce a percutaneous transcalcaneal reconstruction technique for the treatment of acute Achilles tendon insertion avulsion, and to assess its short-term effectiveness. Methods Between January 2014 and June 2020, 25 patients with acute Achilles tendon insertion avulsion were treated with the percutaneous transcalcaneal reconstruction technique. There were 24 males and 1 female, with an average age of 44.1 years(range, 34-60 years). The disease duration was 1-5 days(mean, 1.8 days). There were 23 cases of sports injury and 2 cases of fall injury. The preoperative American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was 55.6±6.7 and the visual analogue scale(VAS) score was 4.6±0.5. The operation time, intraoperative blood loss, hospital stay, related complications,the time of weight-bearing standing with a slightly raised heel, and the time of walking with a slightly raised heel were recorded. The AOFAS ankle-hindfoot score and the VAS score were used to evaluate the ankle joint function and the pain.Achilles tendon continuity was examined by color Doppler ultrasonography and healing of the Achilles tendon was examined by MRI. At last follow-up, the Arner-Lindholm scale was used to evaluate the effectiveness. Results The operation time was 45-50 minutes(mean, 46.8 minutes). The intraoperative blood loss was 10-20 mL(mean, 13.8 mL).The hospital stay was 4-6 days(mean, 4.9 days). The color Doppler ultrasonography before discharge showed the continuous recovery of the Achilles tendon. All incisions healed by first intention, and there was no complication such as sural nerve injury or deep venous thrombosis of lower extremity. All patients were followed up 15-50 months(mean,30.3 months). After 14-21 days, the patients started to weight-bearing stand with a slightly raised heel, with an average of17.6 days;they began to walk with a slightly raised heel at 20-28 days, with an average of 23.7 days. MRI showed that the Achilles tendon healed at last follow-up. The AOFAS score was 90.0±3.2 at 6 months after operation and 95.8±4.5 at last follow-up, and the VAS scores were 1.7±0.6 at 6 months and 1.0±0.8 at last follow-up, which were all improved when compared with those before operation(P<0.05);the difference was also significant between the two time points after operation(P<0.05). According to the Arner-Lindholm scale, the effectiveness at last follow-up was excellent in 25 cases.All patients had returned to sports. Conclusion The percutaneous transcalcaneal reconstruction technique is a promising alternative option in treating acute Achilles tendon insertion avulsion, for it can achieve early rehabilitation and better ankle function recovery.