卵圆钳引线桥接缝合治疗急性闭合性跟腱断裂

Sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture

目的探讨利用卵圆钳引线桥接缝合治疗急性闭合性跟腱断裂的疗效。方法采用回顾性病例系列研究分析2019年12月至2021年12月郑州市骨科医院收治的20例急性闭合性跟腱断裂患者临床资料,其中男18例,女2例;年龄24~43岁[(29.5±7.6)岁]。均为单侧损伤,其中左侧13例,右侧7例。所有患者体检跟腱局部触诊有凹陷,Thompson试验阳性。在跟腱内侧做纵向切口,卵圆钳辅助在跟腱近端引3条不可吸收缝线,绕过断端固定至跟骨,断端采取4⁃0可吸收缝线进行束束缝合。记录手术时间和切口长度。比较术后3,6,12个月患侧与健侧踝关节背伸和跖屈活动度、美国足踝外科协会(AOFAS)踝⁃后足评分和跟腱完全断裂评分(ATRS)。观察手术切口愈合及并发症发生情况。结果患者均获随访12~16个月[(13.2±2.5)个月]。手术时间为40~66 min[(52.0±10.3)min]。切口长度为3~4 cm[(3.3±0.7)cm]。术后3,6个月患侧踝关节背伸[(5.6±1.5)°、(10.5±0.2)°]和跖屈活动度[(28.4±3.2)°、(33.5±1.5)°]与健侧比较,差异有统计学意义(P均<0.05);术后12个月患侧踝关节背伸[(13.9±0.7)°]和跖屈活动度[(38.3±4.4)°]与健侧比较,差异无统计学意义(P均>0.05)。术后3,6,12个月AOFAS踝⁃后足评分分别为(58.3±5.4)分、(84.9±7.1)分、(91.8±6.3)分,呈逐渐增高趋势(P均<0.05)。术后3,6,12个月ATRS分别为(60.5±4.9)分、(85.5±9.0)分、(93.1±5.7)分,呈逐渐增高趋势(P均<0.05)。手术切口Ⅰ期愈合。无切口感染、神经损伤及跟腱二次断裂等并发症。2例患者术后1个月在锚钉置入部位出现疼痛,通过积极功能康复,术后4个月症状消除。1例患者术后6个月出现跟腱止点短暂性疼痛,口服非甾体类抗炎药物治疗2周后疼痛消失。结论采用卵圆钳引线桥接缝合治疗急性闭合性跟腱断裂,手术时间短,切口小,术后跟腱功能恢复好,并发症少。

Objective To explore the outcome of sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture.Methods A retrospective case series study was conducted on 20 patients with acute closed Achilles tendon rupture treated in Zhengzhou Orthopedic Hospital from December 2019 to December 2021.There were 18 males and 2 females,with age range of 24⁃43 years[(29.5±7.6)years].All patients were with unilateral injury,involving the left side in 13 patients and right side in 7.Examinations revealed a palpable defect in the Achilles tendon and positive Thompson test.A longitudinal incision was made at the medial edge of the ruptured tendon.Three nonabsorbable sutures were passed through the proximal stump with sponge forceps,bypassed the rupture site and fixed directly into the calcaneal bone.The disrupted tendon ends were aligned by the tendon⁃bundle technique using 4⁃0 absorbable sutures.The operation time and incision length were documented.The ankle joint range of motion(dorsiflexion/plantar flexion),American Orthopedic Foot and Ankle Society(AOFAS)ankle⁃hindfoot score and Achilles tendon total rupture score(ATRS)in the affected and healthy side were compared at 3,6 and 12 months postoperatively.The wound healing and complications were observed.Results All patients were followed up for 12⁃16 months[(13.2±2.5)months].The operation time was 40⁃66 minutes[(52.0±10.3)minutes],with the incision length of 3⁃4 cm[(3.3±0.7)cm].In the affected side at 3 and 6 months postoperatively,the ankle joint dorsiflexion[(5.6±1.5)°,(10.5±0.2)°]and plantar flexion[(28.4±3.2)°,(33.5±1.5)°]showed statistically significant difference compared with the healthy side(all P<0.05).The ankle joint dorsiflexion[(13.9±0.7)°]and plantar flexion[(38.3±4.4)°]in the affected side were not statistically different from that of the healthy side at 12 months postoperatively(all P>0.05).The AOFAS ankle⁃hindfoot score was(58.3±5.4)points,(84.9±7.1)points and(91.8±6.3)points at 3,6 and 12 months postoperatively,showing a gradual rise(all P<0.05).The ATRS was(60.5±4.9)points,(85.5±9.0)points and(93.1±5.7)points at 3,6 and 12 months postoperatively,showing a gradual rise(all P<0.05).All incisions were healed primarily.No patients had wound infection,nerve injury or re⁃rupture.Pain at the anchor insertion site occurred in 2 patients at 1 month after operation and relieved after active functional rehabilitation at 4 months after operation.Transient pain at the Achilles tendon insertion occurred in 1 patient at 6 months after operation,and relieved after 2 weeks of oral non⁃steroidal anti⁃inflammatory drugs treatment.Conclusion For acute closed Achilles tendon rupture,sponge forceps assisted threading with Speedbridge technique can attain short operation time,small incision and good functional recovery,with few complications.