新型微创缝合技术治疗急性闭合性跟腱断裂  

A new minimal incision suture technique for acute close rupture of Achilles tendon

作　　者：王晓宁[1] 朱颖波[1] 黄鑫[1] 汤俊君[1] 张建[1] 吴克俭[1] 

机构地区：[1]解放军总医院第一附属医院创伤骨科,北京100048

出　　处：《中华创伤骨科杂志》2016年第3期187-191,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用新型小切口微创缝合技术治疗急性闭合性跟腱断裂的临床疗效。方法对2008年8月至2014年10月应用自行设计的微创缝合技术治疗的134例急性闭合性跟腱断裂患者资料进行回顾性分析，男130例，女4例；年龄18～52岁，平均37．4岁；左侧93例，右侧41例；受伤至手术时间为1～7d，平均2．5d。133例患者断裂部位分布在跟腱止点近端4．5—6．3cm，1例患者在1．2cm处。患足充分跖屈后，于断端凹陷中点做1．0—1．5cm的横行手术切口，手术钳腱周膜下钳夹梳理远近断端，根据MRI间接标定的腓肠神经走行位置确定安全穿刺点，在硬膜外穿刺针引导下远近端分别经皮交叉置入EthieonMB66不可吸收缝线，切口处打结，直视下消除两断端间隙达紧密接触。术后基于跟腱残端病理结果制定个体化康复方案。结果所有患者术后获8—48个月（平均19．6个月）随访。切口均获Ⅰ期愈合，无切口相关并发症发生；腓肠神经损伤3例；跟腱再断裂4例，其中3例接受再手术，1例选择保守治疗。根据美国足踝外科协会的踝一后足评分平均为99．6分，优133例，良1例，优良率为100％；根据Amer—Lindholm评定法：优99例，良34例，差1例，优良率为99．3％。结论应用新型小切口微创缝合技术治疗急性闭合性跟腱断裂操作简便、可靠，腱周血供损伤小，粘连轻，并发症少，运动功能恢复快，可以完全避免腓肠神经损伤，并最大程度防止再断裂的发生，值得推广。Objective To investigate the clinical efficacy of a new minimal incision suture technique in repair of acute close rupture of Achilles tendon. Methods From August 2008 through October 2014, 134 patients with acute close rupture of Achilles tendon were treated with a self-designed minimally invasive suture technique at our institution. They were 130 men and 4 women, with an average age of 37.4 years （range, from 18 to 52 years）. The left side was injured in 93 patients and the right side in 41. The interval from injury to surgery was 1 to 7 days （average, 2.5 days）. The tendon rupture was located at 4.5 to 6. 3 cm proximal to its insertion in 133 patients, and at 1.2 cm in one. With the ankle held in full plantar flexion, a 1.0 to 1.5 cm transverse incision was made over the palpable defect. Forceps were then used to mobilize the tendon from beneath the paratenon. The safe puncture site was determined by course and distribution of the sural nerve indirectly located by magnetic resonance imaging （MRI）. Ethicon MB66 nonabsorbable suture was passed diagonally through the tendon bulk under epidural puncture needle guidance. The proximal and distal ends of the suture were tied together and buried. The tendon ends were apposed through the transverse incision. Postoperative individual rehabilitation was established based on pathological differentiation for tendon tissue. Results All the patients were followed up for 8 to 48 months （average, 19.6 months）. All the wounds healed at the first stage. No complications happened related to incision. The nervus suralis was injured in 3 patients; tendon re-rupture occurred in 4 patients, 3 of whom received re-operation and one of whom conservative treatment. Their American Orthopaedic Foot and Ankle Society （AOFAS） scores averaged 99.6, giving a good to excellent rate of l00% （133 excellent cases and one good ease）. According to the Aruer-Lindholm evaluation criteria, ankle function was excellent in 99 cases, good in 34 ones and poor in one, giving a good t

关 键 词：跟腱 腱损伤 外科手术 微创性 

分 类 号：R687.2[医药卫生—骨科学]