双向针缝合技术微创修复急性闭合性跟腱断裂的疗效分析  

Minimally invasive repair of acute closed Achilles tendon rupture with two-way needle suture technique

作　　者：曹常松[1] 雷哲[1] 吴建军[1] 杨嵩[1] 陈杰[1] 赵亮亮[1] 朱军方[1] 王爱国[1] Cao Changsong;Lei Zhe;Wu Jianjun;Yang Song;Chen Jie;Zhao Liangliang;Zhu Junfang;Wang Aiguo(Zhengzhou Orthopedic Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院,郑州450000

出　　处：《中华创伤骨科杂志》2023年第7期584-588,共5页Chinese Journal of Orthopaedic Trauma

基　　金：河南省中医药科学研究专项(2018ZY3009)。

摘　　要：目的双向针缝合技术(TNST)微创修复急性闭合性跟腱断裂的疗效。方法回顾性分析2019年6月至2021年6月郑州市骨科医院收治的26例急性闭合跟腱断裂患者资料。男20例,女6例;年龄28(23,31)岁;断端距跟骨止点(4.2±1.3)cm;受伤至手术时间为4.3(2.0,5.0)d;术前MRI检查均为闭合性跟腱断裂。术中采用TNST修复断裂跟腱。记录患者手术时间、切口长度、并发症发生情况、踝关节背伸和跖屈角度;术后按照Arner-Lindholm评分进行优良情况评价。结果本组患者手术时间为(20.0±5.0)min,切口长度为(2.5±0.4)cm。术后切口均Ⅰ期愈合,无切口感染、皮缘坏死、下肢深静脉血栓形成、腓肠神经损伤、跟腱再断裂等并发症发生。所有患者均完成随访,时间(12.0±6.0)个月。末次随访时患者行走正常,患者切口愈合良好,触诊跟腱连续性良好,患者提踵有力,均恢复至跟腱断裂前;踝关节背伸22.6°±3.7°,跖屈25.3°±3.7°;按照Arner-Lindholm疗效评定标准:优25例,良1例,优良率为100%(26/26)。结论TNST微创修复急性闭合跟腱断裂具有创伤小、术后并发症低、疗效可靠等优点。Objective To investigate the efficacy of two-way needle suture technique(TNST)in the minimally invasive repair of acute closed Achilles tendon rupture.Methods From June 2019 to June 2021,26 patients with acute closed Achilles tendon rupture were treated at Zhengzhou Orthopedic Hospital.They were 20 males and 6 females,with a mean age of 28(23,31)years.The rupture end was(4.2±1.3)cm away from the calcaneal insertion,and the interval from injury to operation 4.3(2.0,5.0)d.Preoperative MRI examinations revealed in all the patients closed Achilles tendon rupture which was to be repaired by TNST.The operation time,incision length,incidence of complications,ankle dorsiflexion and plantar flexion were recorded.The Arner-Lindholm scoring was used to evaluate the clinical efficacy.Results The operation time was(20.0±5.0)min and the incision length(2.5±0.4)cm.Postoperatively,all incisions healed by the first stage,with no complications like incision infection,skin edge necrosis,deep vein thrombosis at lower limbs,injury to the sural nerve,or re-rupture of the Achilles tendon.All patients were followed up for(12.0±6.0)months.At the last follow-up,the patients walked normally,their incisions healed well,the continuity of the Achilles tendon was good by palpation,their heel lift was strong,and all their activities were restored to the levels before rupture of the Achilles tendon.The ankle dorsiflexion was 22.6°±3.7°and the plantar flexion 25.3°±3.7°,According to the Arner-Lindholm evaluation,the clinical efficacy was rated as excellent in 25 cases and as good in 1 case,giving an excellent and good rate of 100%(26/26).Conclusion In the minimally invasive repair of acute closed Achilles tendon rupture,TNST shows the advantages of limited surgical invasion,a low incidence of postoperative complications,and reliable curative effects.

关 键 词：跟腱 微创 急性 双向针缝合技术 

分 类 号：R687.2[医药卫生—骨科学]