早期负重对跟腱断裂术后康复影响的临床研究  

Clinical Study on the Effect of Early Weight Bearing on the Rehabilitation of Achilles Tendon Rupture After Operation

作　　者：李陈 董斌 陈廷 周翔[2] LI Chen;DONG Bin;CHEN Ting(The First Affiliated Hospital of Anhui University of Technology / The First People's Hospital of Huainan, Anhui Huainan 232000, China)

机构地区：[1]安徽省淮南市第一人民医院骨科,安徽淮南232000 [2]中山大学附属第一医院骨科,广东广州510000

出　　处：《河北医学》2021年第1期75-79,共5页Hebei Medicine

基　　金：国家青年科学基金项目,(编号:81501049)。

摘　　要：目的:探讨急性闭合性跟腱断裂术后早期负重对愈后效果的影响。方法:将2018年1月至2019年3月淮南市第一人民医院收治的40例闭合性跟腱断裂的手术患者随机分为两组:早负重组20例(男18例),年龄(41.20±8.13)岁;于术后第2日佩戴支具下地部分负重行走,第5周完全负重;对照组20例(男19例),年龄(44.40±10.03)岁,术后石膏固定暂不负重,从第7周更换跟腱靴部分负重,第8周完全负重;两组均于第3周开始踝部被动伸屈锻炼,第7周开始主动伸屈锻炼。两组由同一组医生采用相同术式。两组患者均随访12个月。比较两组术后并发症、跟腱相对静息角(R-ATRA)及跟腱断裂评分(ATRS)情况。结果:术后并发症方面:负重组2例切口延迟愈合;对照组1例切口延迟愈合,1例再断裂,两组差异无统计学意义(P>0.05),12个月两组患者跟腱均愈合。术后第2日R-ATRA分别为:早负重组[-9.50±6.51度(n=20)],对照组[-11.6±6.41度(n=20)],两组间无明显统计学差异(P>0.05);术后2月R-ATRA分别为:早负重组[9.28±7.68度(n=20)],对照组[4.83±11.58度(n=19)]两组间无明显统计学差异(P>0.05);术后第2月及术后1年ATRS评分分别为:早负重组[53.35±9.94(n=20)]、[78.84±5.72(n=19)],对照组[45.47±10.57(n=19)]、[72.83±4.05(n=18)]两组在2月及12月ATRS存在差异(P<0.05),早负重组>对照组。结论:跟腱断裂术后早期负重不增加跟腱延长率及术后并发症的发生率,但能提高患者的满意度,有利于患肢功能恢复。Objective:To investigate the effect of early weight bearing on the recovery of acute closed Achilles tendon rupture.Methods:From January 2018 to March 2019,40 patients with closed Achilles tendon rupture admitted to the First People's Hospital of Huainan City were randomly divided into two groups:20 patients in early weight bearing group(18 males),age(41.20±8.13);20 patients in the control group(19 males),age(44.40±10.03).Ankle extension and flexion exercise was started in the 3rd week in both groups.The two groups were operated by the same doctors.Both groups were followed up for 12 months.The postoperative complications,r-ATRA and ATRs were compared between the two groups.Results:Delayed healing:1 case in control group and 2cases in the weight bearing group;and rerupture:1 case in the control group.There was no significant difference between the two groups(P>0.05).The Achilles tendon in both groups healed in 12 months.On the second day after operation,r-ATRA was as follows:weight bearing group[-9.50±6.51(n=20)],control group[-11.6±6.41(n=20)],there was no significant difference between the two groups(P>0.05);on the second month after operation,r-ATRA was as follows:weight bearing group[9.28±7.68(n=20)],control group[4.83±11.58(n=19)],there was no significant difference between the two groups(P>0.05);ATRs score of the second month after operation and one year after operation were as follows:weight bearing group[53.35±9.94(n=20)],[78.84±5.72(n=19)],control group[45.47±10.57(n=19)],[72.83±4.05(n=18)].The difference is clear.(P<0.05).Conclusion:Early weight bearing after Achilles tendon rupture does not increase the rate of Achilles tendon extension and postoperative complications,and it can improve the satisfaction of patients and is conducive to the recovery of limb function.

关 键 词：跟腱断裂 康复 负重 跟腱延长 功能评分 

分 类 号：R68[医药卫生—骨科学]