超声辅助下经皮微创治疗急性闭合性跟腱断裂  

Ultrasound-assisted minimally invasive percutaneous repair of acute closed Achilles tendon ruptures

作　　者：马文明[1] 丁亮华[1] 何双华[1] 黄智慧[1] 赵镒汶[1] 曹成[1] 王昆[1] 

机构地区：[1]苏州大学附属第三医院创伤骨科,常州213000

出　　处：《中华创伤杂志》2017年第5期441-446,共6页Chinese Journal of Trauma

摘　　要：目的探讨超声辅助下经皮微创治疗急性闭合性跟腱断裂的临床疗效。方法采用回顾性病例系列研究分析2013年1月-2015年6月收治的急性闭合性跟腱断裂患者24例，其中男19例，女5例；年龄18～50岁，平均30．5岁。MRI检查示跟腱完全断裂，受伤至手术时间1～3d。均在高频超声辅助下，采用改良经皮微创缝合跟腱断端。记录手术时间，观察术中及术后并发症情况。末次随访按美国足踝外科协会（AOFAS）踝-后足评分系统及Amer Lindhdm标准评价对踝关节功能。结果手术时间35～60min，平均42min。术中未发生重要血管、神经等组织结构损伤。患者均获随访10～18个月，平均14．5个月。无皮肤感染、坏死或跟腱再断裂发生，踝关节功能良好。AOFAS踝-后足评分由术前53—74分[（61．5±6．7）分]提高到末次随访时的91～100分[（97．1±3．2）分]（P〈0．05）。按Arner Lindholm标准：优21例，良3例，优良率100％。结论超声引导下经皮微创治疗急性闭合性跟腱断裂，可提高跟腱吻合的质量，避免损伤腓肠神经，降低术后跟腱再断裂、切口感染、皮肤坏死等并发症的发生率，是治疗急性闭合性跟腱断裂的理想方法。Objective To investigate the clinical effect of minimally invasive percutaneous repair of acute closed Achilles tendon ruptures with intraoperative ultrasound assistance. Methods A retrospective case series study was made on 24 patients with acute closed Achilles tendon ruptures hospitalized between January 2013 and June 2015. There were 19 males and five females, aged 18-50 years （mean, 30.5 years）. MRI showed total Achilles tendon ruptures, and time from injury to operation was 1-3 days. All patients underwent minimally invasive percutaneous repair with high-frequency ultrasound assistance. Operation time and either intraoperative or postoperative complications were documented. At last follow-up, American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and Arner Lindholm system were used to evaluate ankle functional recovery. Results Operation time was 35- 60 minutes （mean, 42 minutes ）. No intraoperative injury to the major vessel and ne,＇ve occurred. Follow-up was conducted for 10-18 months （mean, 14.5 months）. No surgery-related complications were detected, including wound infection, skin necrosis and tendon reruptures. Ankle function was recovered to normal. AOFAS score were improved from preoperative 53-74 points [ （61.5 ± 6.7 ） points] to 91- 100 points [ （97. 1 ± 3.2）points] at last follow-up （P 〈 0.05）. According to the Arner Lindhohn system, the treatment outcome was excellent in 21 patients and good in three, with the excellence rate of 100%. Conclusion Ultrasound-assisted minimally invasive percutaneous technique improves the quality of tendon anastomosis, avoids injury to the sural nerve, minimizes the incidence rate of complications such as re-rupture, wounds infections or skin necrosis and hence is an ideal method for repair of acute closed Achilles tendon ruptures.

关 键 词：跟腱 超声检查 外科手术 微创性 

分 类 号：R687.2[医药卫生—骨科学]