微创小切口改良Bunnell缝合法治疗急性闭合性跟腱断裂的疗效观察  

Clinical efficacy of modified minimal incision Bunnell suture for acute closed Achilles tendon rupture

作　　者：张韶民 谢纪宝 王斌 王庆生 周庆芳 杨林 张勇 Zhang Shaomin;Xie Jibao;Wang Bin;Wang Qingsheng;Zhou Qingfang;Yang Lin;Zhang Yong(Department of Orthopedics,General Hospital of Pingmei Shenma Group,Pingdingshan,Henan 467000,China)

机构地区：[1]平煤神马集团总医院骨外科,河南平顶山467000

出　　处：《创伤外科杂志》2023年第11期843-848,共6页Journal of Traumatic Surgery

基　　金：河南省医学科技计划项目(LHGJ20210836)。

摘　　要：目的观察微创小切口改良Bunnell缝合法治疗急性闭合性跟腱断裂的临床疗效,为急性闭合性跟腱断裂的临床合理诊疗提供参考依据。方法回顾性分析2020年3月—2021年3月平煤神马集团总医院骨外科收治的急性闭合性跟腱断裂患者100例。男性70例,女性30例;年龄22~49岁,平均32.8岁;左侧64例,右侧36例;损伤至手术时间3~14d,平均7.7d;体质量指数:18~29kg/m^(2),平均23.4kg/m^(2);Myerson分型:I型65例,II型35例;均为运动致伤。根据不同的手术方式分为传统组(n=48)和微创组(n=52),传统组接受传统切开缝合术治疗,微创组接受微创小切口改良Bunnell缝合法治疗。观察并比较两组患者围术期指标、踝关节功能、踝关节活动度、并发症发生率。结果两组患者优良率组间比较差异无统计学意义(93.8%vs.94.2%,P>0.05)。微创组术中出血量[(13.4±2.3)mL vs.(26.3±3.6)mL]少于传统组,手术时间[(41.5±5.5)min vs.(47.6±4.6)min]、下地行走时间[(3.3±0.5)d vs.(6.8±0.7)d]、完全负重活动时间[(24.2±0.4)周vs.(26.5±1.0)周]、住院时间[(6.4±0.9)d vs.(8.8±1.4)d]均短于传统组(P<0.05)。术后2周,微创组的视觉模拟评分低于传统组[(2.5±0.4)分vs.(4.3±0.6)分,P<0.05]。传统组、微创组术后10周、24周踝关节主动、被动背屈活动度均较术前逐渐升高(P<0.05),微创组术后10周踝关节主动、被动背屈活动度[(15.8±1.3)°vs.(12.4±1.1)°、(18.6±2.1)°vs.(15.0±2.0)°]大于传统组(P<0.05),微创组的并发症发生率(3.85%)低于传统组(16.67%,P<0.05)。结论与传统切开缝合术比较,微创小切口改良Bunnell缝合法可获得相当的临床效果,但其具有创伤相对更小、并发症发生率更低、术后恢复更快的明显优势。Objective To observe the clinical efficacy of modified minimally invasive small incision Bunnell suture in the treatment of acute closed Achilles tendon rupture(ATR)and to provide reference for clinical diagnosis and treatment of this injury.Methods Clinical data of 100 patients with acute closed ATR who were treated in the Orthopedics Department of General Hospital of Pingmei Shenma Group from Mar.2020 to Mar.2021 were analyzed retrospectively,including 70 males and 30 females aged 22-49 years,32.8 years on average.Among them,64 cases injured the left side and 36 the right side.Time from injury to operation was 3-14 d,mean 7.7 d.The body mass index was 18-29 kg/m^(2),mean 23.4 kg/m^(2).Myerson classification revealed 65 cases of type I and 35 type II.All the injuries were caused by sports activities.Patients were divided into traditional group(n=48)who received traditional incision and suture,and the minimally invasive group(n=52)who received minimally invasive small incision modified Bunnell suture.Perioperative indexes,ankle function,ankle range of motion,and incidence of complications were observed and compared between the two groups.Results There was no significant difference in the excellent rate between the two groups(93.8%vs.94.2%,P>0.05).Compared with the traditional group,the minimally invasive group showed significantly better results,with less intraoperative bleeding(mL,13.4±2.3 vs.26.3±3.6),shorter operation time(min,41.5±5.5 vs.47.6±4.6),quicker off-bed walking(d,3.3±0.5 vs.6.8±0.7),full-weight bearing activities(weeks,24.2±0.4 vs.26.5±1.0),and shorter hospitalization(d,6.4±0.9)vs.8.8±1.4),as well as lower visual analogue scale(VAS)score(2.5±0.4 vs.4.3±0.6)at postoperative 2 weeks(all P<0.05).The active and passive ankle dorsiflexion range of motion(ROM)in the traditional group were improved at 10 and 24 weeks after surgery,revealing significant difference(all P<0.05 compared with that before surgery).The minimally invasive group showed the same trend(all P<0.05,compared with that before

关 键 词：急性闭合性跟腱断裂 微创小切口 改良Bunnell缝合法 临床疗效 

分 类 号：R687.2[医药卫生—骨科学]