多孔金属板辅助下微创跟腱修补术与传统开放式手术治疗急性闭合性跟腱断裂的比较

Comparison between minimally invasive achilles tendon repair assisted by porous metal plate and traditional open treatment for acute closed achilles tendon rupture

目的比较多孔金属板辅助下微创跟腱修补术与传统开放式手术治疗急性闭合性跟腱断裂的疗效。方法将2019年3月至2023年8月在衡水市第四人民医院骨科收治的126例急性闭合性跟腱断裂患者按照随机数字表法分成开放组与微创组。开放组63例采用传统开放式手术治疗,微创组63例采用多孔金属板辅助下微创跟腱修补术治疗。比较2组的临床指标(手术历时、切口长度、术中出血量、下床活动时间、住院时间)、踝关节功能[美国矫形足踝协会踝-后足评分法(AOFAS-AH)评分]、踝关节活动度(踝背伸、跖屈)、临床疗效以及并发症(腓肠神经损伤、切口感染、跟腱再断裂、肌腱黏连、深静脉血栓)。结果微创组手术时长、切口长度、术中出血量、下床活动时间、住院时间均少于开放组(P<0.05);2组术后3个月的AOFAS-AH评分均升高(P<0.05),且微创组术后3个月的AOFAS-AH评分高于开放组(P<0.05);2组术后3个月踝背伸、跖屈的活动度均增大(P<0.05),且微创组术后3个月踝背伸、跖屈的活动度大于开放组(P<0.05);微创组优良率高于开放组(P<0.05);微创组并发症发生率低于开放组(P<0.05)。结论多孔金属板辅助下微创跟腱修补术治疗急性闭合性跟腱断裂的有效性与安全性优于传统开放式手术治疗,能够促进患肢踝关节功能尽快恢复,提高踝关节活动度,减少并发症。

Objective To compare the efficacy of minimally invasive Achilles tendon repair assisted by porous metal plates with traditional open surgery in the treatment of acute closed Achilles tendon rupture.Methods One hundred and twenty-six patients with acute closed Achilles tendon rupture admitted to the Orthopedics Department of the Fourth People′s Hospital of Hengshui from March 2019 to August 2023 were randomly divided into an open group and a minimally invasive group.The open group consisted of 63 patients who underwent traditional open surgery,while the minimally invasive group consisted of 63 patients who underwent minimally invasive Achilles tendon repair assisted by porous metal plates.Compare the clinical indicators(surgical duration,incision length,intraoperative bleeding,time to get out of bed,length of hospital stay),ankle joint function(AOFAS-AH score),ankle joint range of motion(ankle dorsiflexion,plantar flexion),clinical efficacy,and complications(sural nerve injury,incision infection,Achilles tendon re rupture,tendon adhesion,deep vein thrombosis)between the two groups.Results The duration of surgery,incision length,intraoperative bleeding,time to get out of bed activity,and hospitalization days in the minimally invasive group were all lower than those in the control group(P<0.05).The AOFAS-AH scores of both groups increased at 3 months after surgery(P<0.05),and the AOFAS-AH scores of the minimally invasive group were higher than those of the open group at 3 months after surgery(P<0.05).The activity of ankle dorsiflexion and plantar flexion increased in both groups at 3 months after surgery(P<0.05),and the activity of ankle dorsiflexion and plantar flexion in the minimally invasive group was higher than that in the open group at 3 months after surgery(P<0.05);The excellent and good rate in the minimally invasive group was higher than that in the open group(P<0.05).The incidence of complications in the minimally invasive group was lower than that in the open group(P<0.05).Conclusions The effectiveness and safety of minimally invasive Achilles tendon repair assisted by porous metal plates in the treatment of acute closed Achilles tendon rupture are superior to traditional open surgery with advantages such as short surgical duration,small incision,low intraoperative bleeding,and fast postoperative recovery,which can promote the rapid recovery of ankle joint function,improve ankle joint mobility and reduce complications.