多孔金属板辅助下微创跟腱修补术对急性闭合性跟腱断裂的疗效观察

Efficacy of minimally invasive Achilles tendon repair assisted by porous metal plates in the treatment of acute closed Achilles tendon rupture

目的观察多孔金属板辅助下微创跟腱修补术对急性闭合性跟腱断裂的疗效。方法将110例急性闭合性跟腱断裂患者随机分为对照组与观察组,每组55例。对照组采用传统跟腱龙修补术,观察组采用多孔金属板辅助下微创跟腱修补术,随访6个月。比较2组临床指标(手术时间、手术切口长度、术中失血量、下地行走时间、住院时间、完全负重时间、跟腱愈合时间)、美国矫形足踝协会(AOFAS)踝-后足评分、跟腱完全断裂评分(ATRS)、实验室指标[转化生长因子-β1(TGF-β1)、骨形态发生蛋白-2(BMP-2)]、临床疗效和并发症发生情况。结果观察组手术时间、手术切口长度、术中失血量、下地行走时间、住院时间、跟腱愈合时间、完全负重时间分别短于或少于对照组,差异有统计学意义(P<0.05);末次随访时,2组AOFAS踝-后足评分、ATRS均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);术后6周时,2组TGF-β1、BMP-2水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组优良率为94.55%,高于对照组的81.82%,差异有统计学意义(P<0.05);观察组并发症总发生率为3.64%,低于对照组的14.55%,差异有统计学意义(P<0.05)。结论多孔金属板辅助下微创跟腱修补术对急性闭合性跟腱断裂的疗效较好,能加快术后康复,改善患肢功能,提高TGF-β1、BMP-2水平,且多孔金属板更贴合病变组织生理解剖形态,可大大减少手术相关损伤和并发症,相较于跟腱龙修补术更具有优势。

Objective To observe the efficacy of minimally invasive Achilles tendon repair assisted by porous metal plates in the treatment of acute closed Achilles tendon rupture.Methods A total of 110 patients with acute closed Achilles tendon rupture were randomly divided into control group and observation group,with 55 patients in each group.Patients in the control group were treated with traditional heel reconstruction by Achillon repair,and patients in the observation group were treated with minimally invasive Achilles tendon repair assisted by porous metal plates.The follow-up period was 6 months.The clinical indicators(operation time,surgical incision length,intraoperative blood loss,bed-off walking time,hospital stay,full weight bearing time,Achilles tendon healing time),American Association of Foot Surgery(AOFAS)ankle hind foot score,Achilles Tendon Complete Rupture Score(ATRS),laboratory indicators[transforming growth factor-β1(TGF-β1),bone morphogenetic protein-2(BMP-2)],clinical efficacy and occurrence of complications were compared.Results The operation time,surgical incision length,intraoperative blood loss,bed-off walking time,hospital stay,healing time of Achilles tendon,and total weight bearing time in the observation group were shorter or less than those in the control group(P<0.05);the levels of TGF-β1 and BMP-2 in both groups were higher at 6 weeks after surgery compared with before surgery,and were higher in the observation group than those in the control group(P<0.05);the excellent and good rate of the observation group was 94.55%,which was higher than 81.82%of the control group(P<0.05);the total incidence of complications in the observation group was 3.64%,which was lower than 14.55%in the control group(P<0.05).Conclusion The minimally invasive Achilles tendon repair assisted by porous metal plates has a good effect in the treatment of acute closed Achilles tendon rupture.It can accelerate postoperative rehabilitation,improve the function of the affected limb,increase the levels of TGF-β1 and BMP-2.Besides,the porous metal plate is more closely fitted to the physiological and anatomical morphology of the pathological tissue,which can greatly reduce surgery-related injuries and complications,and has more advantages than Achillon repair.