卵圆钳辅助穿针结合改良Bunnell技术与传统开放性手术治疗急性闭合跟腱断裂的疗效比较

Comparison of the efficacy of oval forceps-assisted needle threading combined with modified Bunnell technique and traditional open surgery in treating acute closed Achilles tendon rupture

目的比较卵圆钳辅助穿针结合改良Bunnell技术与传统开放性手术治疗急性闭合跟腱断裂的疗效。方法选取2016年1月至2021年12月在龙泉市人民医院行手术治疗的急性闭合跟腱断裂患者80例为研究对象,其中采用开放性手术治疗40例(开放手术组),采用卵圆钳辅助穿针结合改良Bunnell技术治疗40例(微创手术组)。比较两组患者手术相关指标、功能恢复情况、术后随访情况和超声影像学评估结果等。结果微创手术组患者手术时间、住院时间、伤口愈合时间、手术切口长度、患肢完全负重活动时间均短于开放手术组,术中出血量少于开放手术组,术后6个月视觉模拟评分法评分低于开放手术组,美国足与踝关节协会评分、踝跖屈-背伸活动度值均高于开放手术组,差异均有统计学意义(均P<0.05)。两组患者术后12周的超声影像评估结果均优于术后6周,且微创手术组患者术后6、12周的超声影像评估结果均优于开放手术组,差异均有统计学意义(均P<0.05)。结论与传统开放性手术比较,卵圆钳辅助穿针结合改良Bunnell技术治疗急性闭合跟腱断裂的疗效更好,适合基层医院临床开展并推广。

Objective To compare the efficacy of oval forceps-assisted needle threading combined with modified Bunnell technique and traditional open surgery in the treatment of acute closed Achilles tendon rupture.Methods Eighty patients with acute closed Achilles tendon rupture who underwent surgical treatment at Longquan People's Hospital from January 2016 to December 2021 were selected as the research subjects.Among them,40 cases were treated with open surgery(open surgery group),while another 40 cases received oval forceps-assisted needle threading combined with modified Bunnell technique(minimally invasive surgery group).The surgery-related indicators,functional recovery,follow-up results and ultrasound imaging results were compared between the two groups of patients.Results The minimally invasive surgery group had shorter operation time,hospitalization time,wound healing time,surgical incision length,and full weightbearing activity time of the affected limb compared with the open surgery group;the intraoperative blood loss was less;and the postoperative visual analogue scale(VAS)score was lower in the minimally invasive surgery group in comparison with the open surgery group;the American Orthopedic Foot and Ankle Society(AOFAS)score and range of motion(ROM)value of ankle plantar flexion-dorsiflexion were higher than those of the open surgery group,and the differences were statistically significant(all P<0.05).In both groups,results evaluated through ultrasound imaging 12 weeks after surgery were superior than those evaluated 6 weeks after surgery,and further,the ultrasound imaging evaluation at 6 and 12 weeks after surgery both showed statistically better results in the minimally invasive surgery group(all P<0.05).Conclusion The oval forceps-assisted needle threading combined with the modified Bunnell technique has a satisfactory clinical effect in the treatment of acute closed Achilles tendon rupture,which is superior to the traditional open surgery method and is suitable for clinical development and promotion in primary hospitals.