环钳经皮缝合与开放缝合治疗急性闭合性跟腱断裂的比较研究  

Comparison of percutaneous suturing with sponge forceps and open suturing for repair of acute closed Achilles ruptures

作　　者：秦余焕 李建扬[2] 杨先腾[2] 李森磊[2] 孙立[2] 

机构地区：[1]贵州医科大学,贵阳550000 [2]贵州省人民医院骨科,贵阳550000

出　　处：《中华创伤骨科杂志》2017年第6期500-504,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较环钳经皮缝合与开放缝合治疗急性闭合性跟腱断裂的疗效。方法对2011年3月至2014年6月纳入的40例急性闭合性跟腱断裂患者采用前瞻性研究，将患者采用随机数字表法分为开放组（采用常规开放手术治疗）和环钳组（采用环钳经皮缝合手术治疗）（n=20），比较两组患者的手术时间、切口长度、术中出血量、住院时间、切口愈合情况、并发症发生情况及术后3、6、12个月评估踝关节功能的美国足踝外科协会（AOFAS）踝．后足评分。结果环钳组患者的手术时间（中位数为32．5min）、切口长度（中位数为1．5cm）、住院时间（中位数为7．0d）均少于开放组（60．0min、8．0cm、8．5d），差异有统计学意义（P〈0．05）。环钳组患者术中平均出血量[（15．1±13．7）mL]少于开放组[（54．2±33．9）mL]，差异有统计学意义（P〈0．05）。开放组患者平均随访16．8个月（12～23个月），切口表皮感染3例，术后3、6、12个月平均AOFAS踝．后足评分分别为（91．2±5．1）分、（95．2±2．8）分、（97．8±1．6）分。环钳组患者平均随访15．6个月（12～24个月），切口均甲级愈合，术后3、6、12个月平均AOFAS踝．后足评分分别为（90．6±5．3）分、（94．1±2．6）分、（97．0±2．6）分。环钳组患者AOFAS踝．后足评分较开放组低，但差异无统计学意义（P〉0．05）。两组患者均无腓肠神经损伤及跟腱再断裂发生。结论与开放手术相比，环钳经皮缝合治疗急性闭合性跟腱断裂操作简便，无需使用特殊器械，术后切口并发症发生率低，且短期疗效可靠。Objective To compare percutaneous suturing with sponge forceps and open suturing for repair of acute closed Achilles ruptures. Methods From March 2011 to June 2014, 40 patients with acute closed Achilles rupture were enrolled in this study and randomized into 2 equal groups （n = 20） which were subjected to percutaneous suturing with sponge forceps or open suturing. The operative time, incisive length, blood loss, wound healing, hospitalization time and complications were compared between the 2 groups. Their ankle functions were evaluated at postoperative 3, 6, and 12 months according to American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot scores. Results The operative time （median, 60.0 min）, hospitalization time （median, 8.5 d） and incisive length （median, 8.0 era） in the open suturing group were significantly greater than those in the sponge forceps group （32.5 min, 7.0 d and 1.5 cm） （ P 〈 0. 05）. The blood loss （15.1 ± 13.7 mL） in the sponge forceps group was significantly less than in the open suturing group （54. 2 ± 33.9 mL） （ P 〈0. 05）. The open suturing group received an average follow-up of 16.8 months （from 12 to 23 months）, witnessed superficial skin infection in 3 cases, and obtained AOFAS scores of 91.2±5. 1, 95.2 ±2. 8 and 97.8 ± 1.6 at 3, 6, and 12 months postoperatively. The sponge forceps group received an average follow-up of 15.6 months （from 12 to 24 months）, witnessed wound healing in all cases, and obtained AOFAS scores of 90. 6 ± 5.3, 94. 1 ± 2. 6 and 97.0 ± 2. 6 at 3, 6, and 12 months postoperatively. The sponge forceps group obtained insignificantly lower AOFAS scores than the open suturing group （ P 〉 0. 05 ）. No injury to the sural nerve or tendon rerupture happened in either group. Conclusions In treatment of acute closed Achilles ruptures, compared with open suturing, pereutaneous suturing with sponge forceps may he relatively easier without using special equipment, and additionally, may lead to lower incide

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]