有限切开无结桥接治疗急性闭合性跟腱断裂

Limited-incision knotless repair for acute closed Achilles tendon ruptures

背景:跟腱断裂在临床上是一种常见的骨科疾病,传统手术方式切口大,并发症产生概率高,探索其微创手术治疗有助于促进患者快速康复。目的:探讨有限切开无结桥接治疗急性闭合性跟腱断裂的临床疗效及可行性。方法:回顾性分析2019年1月至2020年5月南京医科大学附属常州第二人民医院收治的22例急性闭合性跟腱断裂患者的临床资料,所有患者均采用有限切开无结桥接手术治疗,术后随访12个月以上。记录患者术中出血量、手术时间、住院时间,对比术前与末次随访时的美国足踝外科协会踝-后足功能评分、疼痛目测类比评分、Fugl-Meyer评定量表下肢评分、跟腱完全断裂评分,分析随访期并发症及末次随访的临床疗效(采用Amer-Lindholm标准)。结果与结论:①所有患者均完成随访,术后均未出现切口并发症,Amer-Lindholm标准疗效优18例(82%)、良4例(18%),优良率100%;②末次随访时患者的Fugl-Meyer评定量表下肢评分、跟腱完全断裂评分均高于术前,目测类比评分低于术前,差异均有显著性意义(P<0.05);③末次随访时患者患侧的美国足踝外科协会踝-后足功能评分、Fugl-Meyer评定量表下肢评分、跟腱完全断裂评分与健侧相比差异均无显著性意义(P>0.05);④提示有限切开无结桥接技术治疗急性跟腱断裂,操作简单、术后并发症少、功能恢复满意。

BACKGROUND:Achilles tendon rupture is a common orthopedic disease in clinical practice.The traditional surgical method results in a large incision and has the high probability of complications.Exploring a minimally invasive surgical treatment is helpful to enhance patient rapid recovery.OBJECTIVE:To investigate the clinical efficacy and feasibility of limited-incision knotless bridging in the treatment of acute closed Achilles tendon rupture.METHODS:The clinical data of 22 patients with acute closed Achilles tendon rupture treated in Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from January 2019 to May 2020 were retrospectively analyzed.All patients were treated with limited-incision knotless bridging surgery and were followed up for over 12 months.The amount of intraoperative bleeding,operation time,and hospital stay were recorded.The American Orthopaedic Foot&Ankle Society score for ankle-hindfoot function,visual analog scale score,Fugl-Meyer Rating Scale score for the lower limbs and Achilles tendon complete rupture score were compared before operation and at the last follow-up.The complications during follow-up and the curative effect at the last follow-up were analyzed as per the Amer Lindholm evaluation standard.RESULTS AND CONCLUSION:All patients were followed up without incision complications.As per the Amer Lindholm evaluation standard,excellent was in 18 cases(82%)and good in 4 cases(18%).The excellent and good rate was 100%.At the last follow-up,the American Orthopaedic Foot&Ankle Society score,the Fugl-Meyer Rating Scale score for the lower limbs,and Achilles tendon complete rupture score were significantly higher than those before operation,and the visual analogy score was significantly lower than that before operation(P<0.05).At the last follow-up,there was no significant difference between the affected and health sides in terms of the American Orthopaedic Foot&Ankle Society score for ankle-hindfoot function,visual analog scale score,Fugl-Meyer Rating Scale score for the lower limbs,and Achilles tendon complete rupture score(P>0.05).To conclude,the limited-incision knotless bridging technique in the treatment of acute Achilles tendon rupture has the advantages of simple operation,less postoperative complications and satisfactory functional recovery.