改良单切口与传统双切口[足母]长屈肌腱转位术治疗MyersonⅢ型中老年陈旧性跟腱断裂的疗效比较  

Comparison of efficacy of modified single‑incision and traditional double‑incision for flexor hallucis longus tendon transfer in the treatment of Myerson type Ⅲ chronic Achilles tendon ruptures in the middle‑aged and elderly patients

作　　者：许文博 黄雷[2] 姚陆丰[2] 张峰[2] 汪海清[2] 叶招明[1] Xu Wenbo;Huang Lei;Yao Lufeng;Zhang Feng;Wang Haiqing;Ye Zhaoming(Department of Orthopedics,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Foot and Ankle Surgery,Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009 [2]宁波市第六医院足踝外科,宁波315040

出　　处：《中华创伤杂志》2023年第4期354-360,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(32060139);浙江省医药科技项目(2021KY329);宁波市自然科学基金项目(2021J022);宁波市科技惠民项目(2017C50048);宁波市鄞州区科技项目(2020AS073)。

摘　　要：目的比较改良单切口与传统双切口[足母]长屈肌腱转位术治疗MyersonⅢ型中老年陈旧性跟腱断裂的效果。方法采用回顾性队列研究分析2015年1月至2021年5月宁波市第六医院收治的106例MyersonⅢ型中老年陈旧性跟腱断裂患者临床资料,其中男54例,女52例;年龄48~82岁[(67.2±8.4)岁]。60例行改良单切口[足母]长屈肌腱转位术(改良单切口组),46例行传统双切口[足母]长屈肌腱转位术(传统双切口组)。比较两组手术时间、术中出血量。比较两组术前、术后12个月及末次随访时美国足踝外科协会(AOFAS)踝‑后足评分、足与踝功能评分(FAOS)、视觉模拟评分(VAS)、恢复行走时间及恢复生活自理能力时间。比较两组并发症发生率。结果患者均获随访16~52个月[(37.4±9.5)个月]。改良单切口组手术时间为(51.6±7.4)min,术中出血量为(16.6±3.9)ml;传统双切口组分别为(72.8±7.5)min、(32.9±5.2)ml(P均<0.01)。两组术前AOFAS踝‑后足评分、FAOS、VAS差异无统计学意义(P均>0.05)。术后12个月及末次随访时两组AOFAS踝‑后足评分和VAS差异无统计学意义(P均>0.05);改良单切口组FAOS分别为(112.6±3.0)分、(114.4±3.1)分,传统双切口组分别为(110.8±4.1)分、(112.7±4.3)分(P<0.05或0.01)。术后12个月及末次随访时两组AOFAS踝‑后足评分、FAOS及VAS较术前显著提高或降低(P均<0.05)。所有患者恢复伤前日常活动,其中改良单切口组恢复行走时间为(9.6±2.0)周,恢复生活自理能力时间为(12.7±1.7)周;传统双切口组分别为(10.8±1.8)周和(13.7±1.9)周(P均<0.01)。改良单切口组1例切口浅表感染,口服抗生素后治愈。传统双切口组2例切口浅表感染,1例深部感染,1例深静脉血栓形成,1例足底内侧神经损伤,均内科对症治疗后治愈;2例爪形趾畸形,垫定制鞋垫及功能锻炼后无疼痛等不适。改良单切口组并发症发生率为1.7%(1/60),传统双切口组为15.2%(7/46)(P<0.01)。Objective To compare the efficacy of modified single‑incision and traditional double‑incision for flexor hallucis longus tendon transfer in the treatment of Myerson type Ⅲ chronic Achilles tendon ruptures in the middle‑aged and elderly patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 106 patients with Myerson type Ⅲ chronic Achilles tendon ruptures admitted to Ningbo No.6 Hospital from January 2015 to May 2021,including 54 males and 52 females;aged 48‑82 years[(67.2±8.4)years].Flexor hallucis longus tendon transfer was assigned to 60 patients using modified single‑incision(modified single‑incision group)and to 46 patients using traditional double‑incision(traditional double‑incision group).The operation time,intraoperative blood loss as well as American foot and ankle society(AOFAS)ankle‑hindfoot score,foot and ankle outcome score(FAOS),visual analogue score(VAS)before operation,at postoperative 12 months and at the last follow‑up were compared between the two groups.Time to recover walking and self‑care ability,and incidence of complications were compared as well.Results All patients were followed up for 16‑52 months[(37.4±9.5)months].The operation time and intraoperative blood loss were(51.6±7.4)minutes and(16.6±3.9)ml in modified single‑incision group compared to(72.8±7.5)minutes and(32.9±5.2)ml in traditional double‑incision group(all P<0.01).There was no significant difference in the AOFAS ankle‑hindfoot score,FAOS and VAS between the two groups before operation(all P>0.05).At postoperative 12 months and at the last follow‑up,AOFAS ankle‑hindfoot score and VAS were not significantly different between the two groups(all P>0.05),but FAOS in modified single‑incision group[(112.6±3.0)points,(114.4±3.1)points]was improved significantly compared with traditional double‑incision group[(110.8±4.1)points,(112.7±4.3)points](P<0.05 or 0.01).At postoperative 12 months and at the last follow‑up,the AOFAS ankle‑hindfoot scor

关 键 词：跟腱 软组织损伤 老年人 

分 类 号：R687.2[医药卫生—骨科学]