倒刺线与传统缝线Kessler缝合法治疗跟腱断裂的疗效比较  

Clinical study on the treatment of Achilles tendon rupture by Kessler suture with barbed thread

作　　者：王泽勇 杨斐 胡波 朱意然 覃健 袁堂波 WANG Zeyong;YANG Fei;HU Bo;ZHU Yiran;QIN Jian;YUAN Tangbo(Department of Orthopedics,Sir Run Run Hospital,Nanjing Medical University,Nanjing,Jiangsu 211100,China)

机构地区：[1]南京医科大学附属逸夫医院骨科,江苏南京211100

出　　处：《手术电子杂志》2022年第3期20-25,共6页Electronic Journal of Medical Operations

基　　金：江苏省卫生健康委员会高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2019093)。

摘　　要：目的比较倒刺线和传统缝线Kessler缝合法治疗跟腱断裂的临床疗效。方法采用回顾性队列研究分析2018年8月—2021年5月期间笔者所在医院收治的共计48例跟腱断裂患者临床资料,其中男性患者31例,女性患者17例;年龄22~48岁[(35.10±5.50)岁]。根据患者所选择接受的手术方案不同分为传统缝线缝合组和倒刺线缝合组。传统缝线缝合组患者共计23例,其中男性患者15例,女性患者8例;年龄25~48岁[(36.48±5.50)岁];倒刺线缝合组患者共计25例,其中男性患者16例,女性患者9例;年龄22~46岁[(33.80±5.20)岁]。比较两组患者手术时间、术后并发症、手术切口愈合时间、疼痛评分及踝关节功能评分情况。结果48例患者均获得随访,时间12~32月[(23.0±3.2)月]。在患者手术时间方面,倒刺线缝合组30~40 min[(31.68±2.06)min]较传统缝线缝合组40~55 min[(46.13±3.76)min]明显减少,差异具有统计学意义(P<0.05);在患者术后并发症方面,倒刺线缝合组0/25较传统缝线缝合组4/23少,差异具有统计学意义(P<0.05)。两组患者在手术切口愈合时间、视觉疼痛评分(Vision algetic standard,VAS)及美国矫形外科足踝协会踝-后足评分系统(American Orthopaedic Foot and Ankle Association Ankleposterior Foot Scoring System,AOFAS)功能评分方面差异无统计学意义(P>0.05)。两组患者用术后疗效优良率评分系统(Amer-Lindholm评分)来评估术后疗效,其中传统缝线缝合组术后疗效优15例患者,良4例患者,3例患者切口皮缘发生部分坏死,经多次换药处理后手术切口愈合;1例患者在术后3周出现缝线排异反应,经局部消毒、包扎以及多次换药保持切口边缘环境干燥直至手术切口完全愈合,优良率为19/23(82.61%);倒刺线缝合组术后疗效优22例患者,良3例患者,无手术切口延迟愈合患者,优良率为25/25(100%)。结论运用Kessler缝合法倒刺线缝合断裂跟腱较传统缝线缝合,在手术时间和患者术后�Objective This study aimed to compare the clinical effect of Kessler stitching of traditional suture and barbed suture in the treatment of Achilles tendon rupture.Methods A retrospective cohort study was conducted to analyze the clinical data of 48 patients with Achilles tendon rupture admitted to our hospital from August 2018 to May 2021,including 31 male patients and 17 female patients,with age range from 22 to 48[(35.10±5.50)]years.The patients were divided into traditional suture group and barbed suture group according to different treatment methods.There were 23 patients in traditional suture group,including 15 males and 8 females,aged 25~48[(36.48±5.50)]years;25 patients in barbed suture group,including 16 males and 9 females,aged 22~46[(33.80±5.20)]years.Operation time,postoperative complications,surgical incision healing time,ankle pain score(VAS score)and ankle function score were compared between the two groups.Results All 48 patients were followed up for 12~32[(23.0±3.2)]months.In terms of operation time,the barbed suture group in 30~40[(31.68±2.06)]min was significantly reduced compared with the traditional suture group in 40-55[(46.13±3.76)min],and the difference was statistically significant(P<0.05).In terms of postoperative complications,0/25 case of the barbed suture group was less than 4/23 cases of the traditional suture group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in incision healing time,ankle pain score(VAS)and AOFAS function score between the two groups(P>0.05).The postoperative efficacy was evaluated by Amer-Lindholm score.In the traditional suture group,the postoperative efficacy was excellent in 15 patients and good in 4 patients.Partial necrosis occurred at the incision skin margin in 3 patients,and the incision healed after multiple dressing changes.One patient developed suture rejection 3 weeks after surgery.Local disinfection,dressing and multiple dressing changes kept the incision edge environment dry until t

关 键 词：跟腱断裂 倒刺线 KESSLER缝合法 术后疗效 

分 类 号：R687.2[医药卫生—骨科学]