摘要
目的探讨使用半自动可弯曲缝合钳的镜下全内连续锁边缝合技术治疗急性跟腱断裂的早期效果。方法本研究为回顾性病例系列研究。回顾性分析2020年4月至2022年3月于中部战区总医院骨科采用镜下全内连续锁边缝合技术治疗的48例急性跟腱断裂患者的临床资料。男性44例,女性4例,年龄(34.8±7.4)岁(范围:24~50岁);体重指数(21.2±2.4)kg/m^(2)(范围:18~26 kg/m^(2));左侧29例(60.4%),右侧19例(39.6%)。在内镜监视下,使用预装高强度缝线的半自动可弯曲缝合钳对跟腱近端进行连续锁边缝合,经腱周膜下空间将缝线尾端引导至跟腱止点小切口处,然后用直径4.5 mm外排锚钉固定。记录手术时间及相关并发症情况,随访时行MRI检查观察跟腱重塑情况,使用跟腱断裂总评分(ATRS)、跟腱静息角和单足提踵高度评估临床效果。采用配对样本t检验比较伤侧与健侧跟腱静息角和单足提踵高度的差异。结果所有患者均获得随访,随访时间(24.1±3.5)个月(范围:18~32个月)。术后12个月MRI检查结果显示跟腱断端重塑良好,信号均匀。末次随访时ATRS[M(IQR)]为95.0(4.7)分。伤侧与健侧的跟腱静息角[(17.1±2.4)°比(17.4±2.6)°,t=1.92,P=0.062]和单足提踵高度[(14.2±1.7)cm比(14.4±1.5)cm,t=1.71,P=0.094]的差异无统计学意义。所有患者未观察到腓肠神经损伤、感染、深静脉血栓形成及跟腱再断裂。1例患者因二次受伤导致锚钉轻微切出,术后5个月移除锚钉。46例患者术后6个月恢复体育活动。结论镜下全内连续锁边缝合技术修复急性跟腱断裂,可获得跟腱断端的稳定连接,手术并发症风险低,早期效果满意。
Objective To evaluate the short-term outcomes of all-inside endoscopic running locked stitch technique for acute Achilles tendon ruptures.Methods This is a retrospective case series study.Forty-eight cases with acute Achilles tendon rupture were treated with the all-inside endoscopic running locked stitch technique from April 2020 to March 2022 at Department of Orthopaedics,General Hospital of Central Theater Command.There were 44 males and 4 females,aged(34.8±7.4)years(range:24 to 50 years).Body mass index was(21.2±2.4)kg/m2(range:18 to 26 kg/m2);There were 29 cases(60.4%)on the left side and 19 cases(39.6%)on the right side.Under endoscopic control,the proximal tendon stumps were stitched with the running locked method using a semi-automatic flexible suture passer.The threads of the high-strength suture were grasped through the paratenon sub-space and then fixed into calcaneal insertion with a knotless anchor.MRI of Achilles tendon was performed to observe the regeneration of Achilles tendon during follow-up.Surgical time and complications were assessed.Achilles tendon total rupture score(ATRS),Achilles tendon resting angle,and heel rise height were utilized to evaluate final clinical outcomes.The differences of bilateral limbs were compared using the paired sample t test.Results The follow-up time was(24.1±3.5)months(range:18 to 32 months).Appropriate tendon regeneration was observed on MRI at 12 months after operation.The median ATRS score(M(IQR))was 95.0(4.7)points.Furthermore,there was no significant difference between the injured and contralateral side in the Achilles tendon resting angle((17.1±2.4)°vs.(17.4±2.6)°,t=1.92,P=0.062)and heel rise height((14.2±1.7)cm vs.(14.4±1.5)cm,t=1.71,P=0.094).No nerve injury,infection,deep vein thrombosis and re-rupture was encountered.Sports activity resumed six months postoperative in 46 patients.One patient had a slight anchor cut-out,due to an addition injury,which was removed after 5 months.Conclusions All-inside endoscopic running locked stitch technique for acute Achilles tendon ruptures shows promising results.It provides stable connection of the tendon stumps with a low risk of complications.
作者
郑博宇
伍河霖
魏世隽
Zheng Boyu;Wu Helin;Wei Shijun(Wuhan University of Science and Technology,Wuhan 430065,China;Department of Orthopaedics,General Hospital of Central Theater Command,Wuhan 430070,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2024年第6期549-555,共7页
Chinese Journal of Surgery
关键词
腱损伤
运动损伤
跟腱
关节镜
微创
缝合技术
Tendon injuries
Athletic injuries
Achilles tendon
Arthroscopy
Minimally invasive
Stitch technique