经跟骨骨隧道线扣技术对跟腱止点或近止点断裂患者手术效果和术后炎症及应激反应的影响

Effect of transcalcaneal bone tunnel suture technique on postoperative inflammation and stress response in patients with Achilles tendon rupture at or near the stop

目的 探讨经跟骨骨隧道线扣技术对跟腱止点或近止点断裂患者手术效果和术后炎症及应激反应的影响。方法 采用回顾性病例对照研究方法,收集2012年6月至2022年10月于衡水市第四人民医院接受手术治疗的106例跟腱止点或近止点断裂患者的病例资料,根据手术方案的不同分为锚钉组和线扣组,锚钉组(53例)采取带线锚钉技术治疗,线扣组(53例)接受经跟骨骨隧道线扣技术治疗。比较两组的术中出血量、手术时间、住院时间、住院费用和跟腱愈合时间,术前和术后12个月踝关节活动度和跟腱完全断裂评分系统(Achilles tendon rupture scoring system, ATRS)、美国足与踝关节协会(American Foot and Ankle Association, AOFAS)踝-后足评分系统评分,术前和术后1 d血清炎症及应激指标[白细胞介素(IL)-1β、去甲肾上腺素(NE)等]水平。统计两组术后并发症情况。结果 所有患者均顺利完成手术并获得随访,随访时间12~23个月,平均(16.62±2.79)个月。线扣组的术中出血量、住院时间、住院费用、跟腱愈合时间均明显少于锚钉组,手术时间明显长于锚钉组,差异有统计学意义(P<0.05)。术后12个月,两组踝关节背屈、跖屈角度及ATRS、AOFAS踝-后足评分系统评分均显著优于术前(P<0.05)。其中,两组踝关节背屈、跖屈角度及ATRS评分组间同期比较差异无统计学意义(P>0.05);术后12个月,线扣组AOFAS踝-后足评分系统评分显著高于锚钉组(P<0.05)。两组术后1 d血清IL-1β、IL-6、NE、血管紧张素Ⅱ(AngⅡ)水平均显著高于术前(P<0.05),但线扣组术后1 d血清IL-1β、IL-6、NE、AngⅡ水平均显著低于同期锚钉组(P<0.05)。术后仅锚钉组出现了2例切口红肿,经伤口换药及延迟拆线,切口均为Ⅰ期愈合。随访12个月内,所有患者均未出现跟腱再次断裂、腓肠神经损伤、切口周围皮肤坏死等其他并发症。结论 跟腱止点或近止点断裂患者采用经跟骨骨隧道线扣技术治疗能明显减轻患者术后机体炎症及应激反应,利于术后康复;与带线锚钉技术相比,该线扣技术具有创伤小、住院费用少等优势,同时还能达到更好的治疗效果。

Objective To investigate the effect of transcalcaneal bone tunnel suture technique on postoperative inflammation and stress response in patients with Achilles tendon rupture.Methods A retrospective case-control study was used to collect the case data of 106 patients with Achilles tendon rupture at or near the Achilles tendon that received surgical treatment at the Fourth People's Hospital of Hengshui from June 2012 to October 2022,and they were divided into anchor group and suture group according to different surgical plans.The anchor group(53 cases)was treated with the wire anchor technique,and the suture group(53 cases)received the transcalcaneal bone tunnel suture technique.Surgical outcomes(including intraoperative blood loss,duration of surgery,length of hospital stay,hospitalization costs,and Achilles tendon healing time),ankle range of motion and complete Achilles tendon rupture scoring system(ATRS),and American Foot and Ankle Association(AOFAS)ankle-posterior foot scoring system scores were compared between the two groups.Serum levels of inflammatory and stress indicators[interleukin-1β,norepinephrine(NE),etc.]were measured before and 1 day after surgery.Postoperative complications of the two groups were analyzed.Results All patients successfully underwent surgery and were followed up for 12 to 23 months,with an average time of(16.62±2.79)months.Intraoperative blood loss,hospital stay,hospital costs and Achilles tendon healing time were significantly lower in the suture group than in the anchor group,and operative time was significantly longer than that in the anchor group,with statistical significance(P<0.05).At 12 months after operation,ankle dorsiflexion,plantar flexion angle,ATRS and AOFAS scores in both groups were significantly better than those before surgery(P<0.05).There was no significant difference in ankle dorsiflexion,plantar flexion angle and ATRS evaluation between the two groups(P>0.05).At 12 months after surgery,the AOFAS score in the suture group was significantly higher than that in the anchor group(P<0.05).The levels of serum IL-1β,IL-6,NE and angiotensinⅡ(AngⅡ)in the two groups were significantly higher than those before surgery 1 day after surgery(P<0.05),but the levels of serum IL-1β,IL-6,NE and AngⅡin suture group were significantly lower than those in the anchor group 1 day after surgery(P<0.05).After operation,only 2 cases of incision redness and swelling appeared in the anchor group.After wound dressing change and delayed suture removal,the incisions were all healed in stageⅠ.No other complications such as Achilles tendon re-rupture,sural nerve injury,and skin necrosis around the incision occurred in all patients within 12 months of follow-up.Conclusion Treatment of patients with Achilles tendon rupture at or near the Achilles tendon can significantly reduce the inflammatory and stress response of patients after surgery,which is beneficial for postoperative rehabilitation.Compared with the wire anchor technique,the transcalcaneal bone suture technique has the advantages of less trauma,lower hospital costs and better therapeutic effect.