急性跟腱断裂微创与传统修复方法的比较  

Minimally invasive versus conventional method repair of acute Achilles tendon rupture

作　　者：陈传煌[1] 杨涛[1] 李文庆[1] 朱小弟[1] 王智[1] 李楚炎[1] 姚海波[1] 毛仁群[1] 张国雷[1] 王利[1] 

机构地区：[1]广东医学院附属南山医院手足显微外科,广东深圳518052

出　　处：《中国临床解剖学杂志》2014年第4期487-490,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨应用方法修复急性跟腱断裂的疗效比较。方法对40例闭合性跟腱断裂患者，断端位于跟骨结节近端2～8cm，随机分为试验组及对照组。试验组采用3．0cm的小切口，卵圆钳及硬脊膜针辅助下微创修复跟腱。对照组采用传统跟腱内侧切口。术后均采用高分子夹板固定足跖屈位4周，4周后改为中立位继续固定2周，6周去除外固定后，进行水疗、伸展及等长收缩等训练。结果术后试验组17例，对照组16例获得随访，随访时间16～24月，平均21月，术后6月按照Arner-indholm评分标准，优88．2％（15例），良11．8％（2例），5．88％（1例）伤口延期愈合。对照组：优62．5％（10例），良31．25％（5例），差6．25％（1例），18．7％（3例）伤口延期愈合，12．5％（2例）出现皮肤边缘坏死，6．25％（1例）出现伤口感染，6．25％（1例）出现跟腱再次断裂。两组间优良率及皮肤坏死率P〈0．05，有临床统计学意义。结论对于急性跟腱断裂，采用小切口微创修复跟腱，早期积极的功能康复训练，比传统的切开修复术式，手术操作简便，吻合方法可靠，创伤小，皮肤坏死率低，功能恢复佳，适应于基层医院开展。Objective To evaluate minimally invasive versus conventional methods for repair of acute Achilles tendon rupture. Methods 40 cases of patients with acute achilles tendon rupture, broken end in the calcaneal tuberosity of proximal 2-8 cm, were divided into two groups, of which 20 patients in the experimental group were treated with minimally invasive surgery with small incision 3 cm in length using the oval forceps and epidural needle while 20 patients in the control group adopted conventional surgical treatment of tendon with a medial incision 8 cm in length. Polymer splint immobilization was used to keep the foot in a position of plantar flexion 4 weeks after surgery, and in the neutral position for 2 weeks. ALL cases need hydrotherapy and stretching and isometric contraction training after removal of external fixation 6 weeks later. Results After operation, 17 cases in the experimental group and 16 cases in the control group were followed up for 16-24 months, averaging 21 months. The therapeutic efficacy of the two treatment modalities was evaluated according to the Arner-indholm score standard six months after surgery. The excellent and good rate and skin necrosis rate of observation group were significantly higher than that in the control group （P〈0.05）. Conclusion For acute Achilles tendon rupture, the small - incision approach carried out with oval forceps and epidural needle is simple in operation, reliable in anastomosis, milder in trauma, lower in skin necrosis rate, better in functional recovery than the control group. Minimally invasive surgery performed with the oval forceps and epidural needle for treatment of rupture of the Achilles tendon has good efficacy, and it is worthy of wider promotion for its application in grassroot hospitals.

关 键 词：跟腱断裂 微创 传统 

分 类 号：R622.2[医药卫生—整形外科]