层叠斜面缝合法修复新鲜闭合性跟腱断裂早期疗效观察  

Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture

作　　者：孙太存[1] 鲁彪[1] 曹兴兵[1] 陈海宁[1] 徐晓峰[1] 崔学文[1] 

机构地区：[1]江苏大学附属医院骨科,江苏镇江212001

出　　处：《中国修复重建外科杂志》2017年第12期1447-1451,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的介绍一种修复新鲜闭合性跟腱断裂的改良方法,初步探讨其临床效果。方法 2011年3月—2015年9月,采用层叠斜面缝合法手术修复8例(8侧)新鲜闭合性跟腱断裂。患者均为男性;年龄22~58岁,平均39.3岁。为运动中损伤,局部无直接暴力。提踵试验及Thompson试验均呈阳性。彩色多普勒超声或MRI检查确定跟腱完全断裂,断端距跟骨止点2~5 cm,平均3.3 cm。伤后至手术时间为2~12 d,平均4.1 d。采用后正中偏内侧纵向切口暴露,将跟腱断端在冠状面上分3层,断端梳理成条带状,交错层叠,跟腱纤维斜面侧侧缝合。术后踝关节跖屈保护位外固定,早期开始康复锻炼。结果手术时间70~135 min,平均99 min;术中出血量5~30 mL,平均15.6 mL。除1例拆线后切口部分裂开,经换药愈合外,其余切口均Ⅰ期愈合,无感染发生。8例均获随访,随访时间6~50个月,平均30.5个月。无腓肠神经损伤、局部疼痛及下肢深静脉血栓形成等并发症发生。所有患者均恢复至跟腱断裂前运动水平,行走正常,提踵有力,未发生跟腱再断裂。与健侧对比,踝关节活动度背伸减少0~6°,平均3°;跖屈减少1~5°,平均2°。末次随访时按照Arner-Lindholm疗效评定标准,优7例,良1例,优良率100%。结论层叠斜面缝合法操作简便,无需特殊器械,可提供早期康复锻炼的抗拉强度,患者恢复快,早期疗效较好。Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases （8 sides） with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years （range, 22-58 years）, injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm （mean, 3.3 cm）. The time from injury to operation was 2-12 days （mean, 4.1 days）. With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes （mean, 99 minutes）; the intraoperative blood loss was 5-30 mL （mean, 15.6 mL）. All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months （mean, 30.5 months）. There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activityof ankle joint dorsiflexion reduced 0-6° （mean, 3°）; plantar flexion reduced 1-5°（mean, 2°）. At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an exce

关 键 词：闭合性跟腱断裂 层叠斜面缝合法 早期疗效 

分 类 号：R687.2[医药卫生—骨科学]