跟腱内侧小切口经皮编织改良Kessler缝合治疗急性闭合性跟腱断裂  

Percutaneous woven modified Kessler suture for a small medial incision of the Achilles tendon in treatment of acute closed Achilles tendon rupture

作　　者：王小龙[1] 韩超前[1] 郝增涛[1] 殷超[1] 温树正[1] 王继宏[1] 樊东升[1] 王永飞[1] 姜东 张国荣 闫学东 孙韬[3] 张志勇[3] 景尚斐[1] Wang Xiaolong;Han Chaoqian;Hao Zengtao;Yin Chao;Wen Shuzheng;Wang Jihong;Fan Dongsheng;Wang Yongfei;Jiang Dong;Zhang Guorong;Yan Xuedong;Sun Tao;Zhang Zhiyong;Jing Shangfei(Department of Hand and Foot Surgery,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China;Department of Orthopaedics,the Second People’s Hospital of Erdos City,Erdos 017200,Inner Mongolia Autonomous Region,China;Department of Emergency Surgery,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学第二附属医院手足显微外科,内蒙古自治区呼和浩特市010030 [2]鄂尔多斯市第二人民医院骨科,内蒙古自治区鄂尔多斯市017200 [3]内蒙古医科大学第二附属医院急诊外科,内蒙古自治区呼和浩特市010030

出　　处：《中国组织工程研究》2020年第23期3667-3672,共6页Chinese Journal of Tissue Engineering Research

基　　金：内蒙古自治区自然科学基金(2016MS0822),项目负责人:王继宏;内蒙古自治区自然科学基金(2017BS0309),项目负责人:景尚斐。

摘　　要：背景:传统开放缝合术治疗急性闭合性跟腱断裂可以明显降低腓肠神经损伤以及跟腱再次断裂的风险,但却增加了切口相关并发症以及组织粘连等问题。虽然Krackow缝合法强度更大,但难以做到小切口微创手术,以及过多的锁扣加强缝合可能会影响跟腱血供。而经皮编织改良Kessler缝合法不仅缝合处光滑平整,相对牢固,而且张力较强,跟腱功能恢复好,还可以做到微创。目的:通过与开放缝合术对比,探讨跟腱内侧小切口经皮编织改良Kessler缝合治疗急性闭合性跟腱断裂的临床疗效。方法:回顾性分析内蒙古医科大学第二附属医院手足显微外科于2015年6月至2018年6月期间诊治的72例急性闭合性跟腱断裂患者临床资料,根据手术方式的不同将患者分为开放组和腱内侧微创组(n=36),分别采用常规开放改良Kessler缝合手术治疗和跟腱内侧小切口经皮编织改良Kessler缝合术治疗,对比两组患者的手术时间、住院时间、术中出血量、切口长度、伤口愈合情况、并发症发生情况以及临床疗效。结果与结论:①与开放组相比,腱内侧微创组的手术时间和住院时间更短、术中出血量更少、切口长度更短(P<0.05);②腱内侧微创组患者治疗后6个月的ATRS评分和AOFAS评分明显高于开放组(P<0.05),但两组患者治疗后1年的ATRS评分和AOFAS评分却无明显差别(P?0.05);③两组患者治疗后1年的临床疗效优良率差异无显著性意义(P?0.05);④腱内侧微创组的总体并发症发生率明显低于开放组(P<0.05),其中主要为切口相关并发症;⑤结果表明,与开放改良Kessler缝合术相比,跟腱内侧小切口经皮编织改良Kessler缝合具有操作简单、价格低廉、围术期指标突出、术后切口并发症发生率低、短期疗效显著等优点。BACKGROUND:Traditional open suture for the treatment of acute closed Achilles tendon rupture can significantly reduce the risk of gastrocnemius nerve injury and re-rupture of Achilles tendon,but this suture method can increase incision-related complications and result in tissue adhesion.Although the Krackow suture method is more powerful,it is difficult to perform minimally invasive surgery with small incisions,and excessive locks to strengthen the suture may affect the blood supply in the Achilles tendon.The percutaneous woven modified Kessler suture method is not only smooth,flat,and relatively strong,but also has strong tension.This is a minimally invasive method that can achieve good functional recovery of the Achilles tendon.OBJECTIVE:To investigate the clinical effect of percutaneous woven modified Kessler suture of a small medial incision of the Achilles tendon in the treatment of acute closed Achilles tendon rupture in comparison with the open suture method.METHODS:Clinical data of 72 patients with acute closed Achilles tendon rupture diagnosed at Department of Hand and Foot Surgery,the Second Affiliated Hospital of Inner Mongolia Medical University between June 2015 and June 2018 were retrospectively analyzed.All patients were divided into open group and minimally invasive group of medial Achilles tendon(n=36 per group).The operation time,hospitalization time,blood loss,length of incision,wound healing,complications,and clinical efficacy were compared between the two groups.The study was approved by the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University in China.RESULTS AND CONCLUSION:Compared with the open group,the minimally invasive group of medial Achilles tendon had shorter operation time and hospitalization time,less blood loss,and shorter incision length(P<0.05).The American Orthopaedic Foot and Ankle Society(AOFAS)and Achilles tendon total rupture(ATRS)scores of the minimally invasive group of medial Achilles tendon were significantly higher than that of the o

关 键 词：跟腱断裂 微创 外科手术 小切口 改良Kessler缝合术 

分 类 号：R459.9[医药卫生—治疗学] R493[医药卫生—临床医学]