经皮微创缝合与传统切开缝合治疗急性闭合性跟腱断裂的比较研究  

Comparison of percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon

作　　者：丁凯 丁亮华[1] 丁文鸽[1] 何双华[1] Ding Kai;Ding Lianghua;Ding Wenge;He Shuanghua(Department of Orthopaedic Trauma,The Third Affiliated Hospital to Soochow University,Changzhou 213000,China)

机构地区：[1]苏州大学附属第三医院创伤骨科,常州213000

出　　处：《中华创伤骨科杂志》2018年第12期1054-1059,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较经皮微创缝合与传统切开缝合治疗急性闭合性跟腱断裂的疗效。方法对2010年11月至2013年11月苏州大学附属第三医院创伤骨科收治的68例急性闭合性跟腱断裂患者采用前瞻性研究,按照接诊顺序单双数分为传统切开组和经皮微创组。传统切开组34例,男31例,女3例;年龄(37.0±10.0)岁;经皮微创组34例,男30例,女4例;年龄(36.4±9.4)岁。记录并比较两组患者的手术时间、术中失血量、术后伤口感染、术后局部皮肤坏死及美国足踝外科协会(AOFAS)的踝一后足评分等。结果所有患者术后均获随访,时间(27.1±3.4)个月(24~36个月)。经皮微创组和传统切开组的手术时间[(75.0±5.3)min和(64.8±3.8)min]、术后局部感染率[2.9%(1/34)和14.7%(5/34)]比较差异均无统计学意义(P>0.05)。经皮微创组患者术中失血量(12.0mL)少于传统切开组(67.5mL),术后伤口皮肤坏死发生率2.9%(1/34)低于传统切开组[29.4%(10/34)],术后6、12、24个月时经皮微创组AOFAS的踝一后足评(90.5、91.5、93.5分)高于传统切开组(80.0、81.0、82.5分),差异均有统计学意义(P<0.05)。结论经皮微创缝合治疗急性闭合性跟腱断裂在术中失血量及术后功能恢复等方面优于传统切开缝合,并可降低术后皮肤坏死发生率,是治疗急性闭合性跟腱断裂的理想方法。Objective To compare the clinical outcomes between percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon.Methods A prospective study was performed in the 68 patients who had been treated for acute occlusive rupture of Achilles tendon from November 2010 to November 2013 at Department of Orthopedic Trauma,The Third Affiliated Hospital to Soochow University.They were randomly assigned by the sequence of medical attention to receive percutaneous minimally invasive suture or conventional open suture.In the conventional group,there were 31 men and 3 women with an average age of 37.0±10.0years;in the minimally invasive group,there were 30 men and 4women with an average age of 36.4±9.4 years.The 2groups were compared in terms of operation time,intraoperative bleeding,postoperative wound infection,postoperative skin necrosis and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results All the 68 cases were followed up for an average of 21.26 months (from 6to 36months).There were no significant differences between the 2 groups in operation time (75.0±5.3min versus 64.8±3.8 min)or in rate of postoperative local infection [2.9%(1/34)versus 14.7%(5/34)](P >0.05).The minimally invasive group had significantly less intraoperative bleeding (12.0mL),a significantly lower rate of skin necrosis [2.9%(1/34)]and significantly higher AOFAS scores at 6(90.5),12(91.5)and 24 months (93.5)postoperatively than the conventional group did (80.0,81.0and 82.5,respectively)(all P <0.05).Conclusion Pcreuta- neous minimally invasive suture is recommendable for treatment of acute closed rupture of Achilles tendon because it leads to less intraoperafive bleeding,better postoperative functional recovery and lower incidence of postoperative skin necrosis.

关 键 词：跟腱 腱损伤 外科手术 微创性 前瞻性研究 

分 类 号：R687.2[医药卫生—骨科学]