手术与非手术治疗急性跟腱断裂的对比研究  

Comparative study on surgical and non-surgical treatment of acute Achilles tendon rupture

作　　者：冯彦华 崔硬铁[1] 周晓康[1] 王诗波 FENG Yanhua;CUI Yingtie;ZHOU Xiaokang;WANG Shibo(Department of Orthopedics,Hebei Children's Hospital,Shijiazhuang050000,China;Department of Orthopaedics,No.904 Hospital of the PLA Joint Logistics Support Force,Wuxi214044,China)

机构地区：[1]河北省儿童医院骨一科,河北石家庄050000 [2]解放军联勤保障部队第九〇四医院骨科,江苏无锡214044

出　　处：《中国现代医生》2020年第30期85-88,92,共5页China Modern Doctor

摘　　要：目的探讨手术与非手术治疗跟腱断裂的临床疗效。方法回顾分析解放军联勤保障部队第九〇四医院2011年1月~2017年10月分别采用手术和非手术治疗74例跟腱断裂患者临床资料。其中手术(非老年)组43例,男28例,女15例;非手术(老年)组31例,男18例,女13例。观察两组跟腱再断裂例数、高风险并发症(手术切口慢性窦道形成需再次手术、切口感染、下肢深静脉血栓形成甚至引起肺栓塞等)、低风险并发症(切口延迟愈合、肉芽肿形成、皮肤跟腱粘连、腓肠神经损伤);回到原工作岗位时间及该时间视觉模拟疼痛(VAS)评分;末次随访踝关节活动受限例数;评定两组末次随访Arner-Lindholm疗效优良率。结果74例患者均获随访,随访时间12~24个月,平均15个月。其中手术组2例、非手术组7例发生跟腱再次断裂(P=0.014);手术组6例、非手术组0例发生高风险并发症(P=0.030);手术组11例、非手术组6例发生低风险并发症(P=0.530);但两组总体并发症比较,差异无统计学意义(P=0.064);手术组平均7.7周、非手术组平均11.2周回到工作岗位(P=0.000);该时间段两组VAS评分比较,差异有统计学意义(P<0.05);手术组7例、非手术组8例患者踝关节活动受限,但不影响患者日常生活(P=0.314);两组末次随访Arner-Lindholm疗效评定优良率比较,差异无统计学意义(P=0.675)。结论手术治疗可以明显降低跟腱再断裂率,但同时也有出现高并发症的风险;手术治疗可以使患者早期回到工作岗位,故手术治疗比较适用对生活质量及运动要求较高的患者,但对于老年人及对日常活动要求较低的低运动量患者,非手术治疗同样可以获得较为满意的疗效,不失为一种较好的选择。Objective To explore the clinical efficacy of surgical and non-surgical treatment of Achilles tendon rupture.Methods The clinical data of 74 patients with Achilles tendon rupture treated by surgical and non-surgical treatment from January 2011 to October 2017 in the No.904 Hospital of the PLA Joint Logistics Support Force were retrospectively analyzed.Among them,the surgical(non-elderly)group had 43 cases including 28 males and 15 females;the non-surgical(elderly)group had 31 cases including 18 males and 13 females.Observation indicators consisted of the number of rerupture of the Achilles tendon,high-risk complications(reoperation for chronic sinus formation of surgical incision,incision infection,deep vein thrombosis of the lower extremity and even cause pulmonary embolism,etc.),low-risk complications(delayed healing of the incision,granulation swelling,skin and Achilles tendon adhesion,sural nerve injury);time to return to the original work position and the VAS(Visual Simulated Pain)score at that time;the number of patients with limited ankle movement at the last follow-up;Arner-Lindholm excellent and good rate assessment at the last follow-up of the two groups.Results All 74 patients were followed up for 12-24 months,with an average of 15 months.Among them,2 cases in the operation group and 7 cases in the non-operation group had re-rupture of the Achilles tendon(P=0.014);6 cases in the operation group and 0 case in the non-operation group had high-risk complications(P=0.030);11 cases in the operation group and 6 patients in the non-operation group had low-risk complications(P=0.530).But there was no statistically significant difference in the overall complications between the two groups(P=0.064).It took 7.7 weeks in the operation group and 11.2 weeks in the non-operation group averagely to return to work(P=0.000).The difference in VAS scores between the two groups was statistically significant(P<0.05).7 patients in the surgery group and 8 patients in the non-surgery group had limited ankle movement,but did no

关 键 词：急性跟腱断裂 手术治疗 保守治疗 

分 类 号：R687.2[医药卫生—骨科学]