带线锚钉经皮与开放缝合急性跟腱断裂的比较  

Percutaneous repair with suture anchors versus open counterpart for acute Achilles tendon rupture

作　　者：骆艳飞 唐冬旭 万喻 陈仕达 邓江 阮世强 LUO Yan-fei;TANG Dong-xu;WAN Yu;CHEN Shi-da;DENG Jiang;RUAN Shi-qiang(The Third Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学第三附属医院创伤骨科,贵州遵义563000

出　　处：《中国矫形外科杂志》2023年第22期2041-2046,共6页Orthopedic Journal of China

基　　金：贵州省科技计划项目(编号:黔科合成果-LC[2022]029)。

摘　　要：[目的]比较经皮与开放缝合治疗急性跟腱断裂的临床疗效。[方法]回顾性分析2017年10月—2021年10月本院手术治疗的急性跟腱断裂35例患者的临床资料,根据术前医患沟通结果,16例采用带线锚钉闭合缝合(经皮组),19例采用切开缝合(开放组)。比较两组围手术期、随访结果。[结果]所有患者均顺利完成手术。经皮组手术时间[(56.6±10.4) min vs(81.7±28.7) min, P=0.003]、切口长度[(1.9±0.6) cm vs (7.7±3.5) cm, P<0.001]、术中失血量[(10.6±6.0) ml vs (26.0±15.8) ml, P<0.001]、住院时间[(8.2±1.6) d vs (11.1±3.5) d, P=0.015]均显著优于开放组,而两组下地行走时间及切口愈合情况的差异均无统计学意义(P>0.05)。随访时间平均(21.8±7.1)个月,经皮组术后完全负重活动时间显著早于开放组[(8.4±1.0)周vs (12.8±3.1)周, P=0.005]。术后随时间推移,两组患者VAS、AOFAS和ATRS评分,以及足跖屈-背伸ROM均显著改善(P<0.05)。经皮组术后1个月[(1.6±0.4) vs (2.3±0.7), P=0.001]和术后6个月[(0.9±0.3) vs (1.3±0.4), P=0.004]的VAS均显著优于开放组,相应时间点,两组间AOFAS、ATRS评分和足跖屈-背伸ROM的差异均无统计学意义(P>0.05)。[结论]与切开缝合治疗相比,带线锚钉经皮缝合手术创伤小,更有利于功能恢复。[Objective]To compare the clinical outcomes of percutaneous repair with suture anchors versus open counterpart for treat-ment of acute Achilles tendon rupture.[Methods]A retrospective study was done on 35 patients who received surgical repair for acuteAchilles tendon rupture in our hospital from October 2017 to October 2021.According to the preoperative doctor-patient communication,16 patients underwent percutaneous repair of the tendon with suture anchor(the percutaneous group),while the remaining 19 patient under-went conventional open repair(open group).The perioperative and follow-up documents were compared between the two groups.[Results]All patients had corresponding surgical procedures performed successfully.The percutaneous group was significantly superior to the opengroup in terms of operation time[(56.6±10.4)min vs(81.7±28.7)min,P=0.003],incision length[(1.9±0.6)cm vs(7.7±3.5)cm,P<0.001],in-traoperative blood loss[(10.6±6.0)ml vs(26.0±15.8)ml,P<0.001],hospital stay[(8.2±1.6)days vs(11.1±3.5)days,P=0.015],but there wasno statistical significance in the walking time and incision healing grade between the two groups(P>0.05).The follow-up period lasted for(21.8±7.1)months in a mean,and the percutaneous group resumed full weight-bearing activity significantly earlier than the open group[(8.4±1.0)weeks vs(12.8±3.1)weeks,P=0.005].The VAS,AOFAS and ATRS scores,as well as plantar flexion-dorsal extension ROM weresignificantly improved in both groups over time(P<0.05).Percutaneous group was significantly better than that of the open group in VASscore at 1 month[(1.6±0.4)vs(2.3±0.7),P=0.001]and 6 months postoperatively[(0.9±0.3)vs(1.3±0.4),P=0.005],despite of insignificantdifferences in terms of AOFAS,ATRS scores and plantar flexion-dorsal extension ROM between the two groups at any time points accord-ingly(P>0.05).[Conclusion]Compared with traditional open repair,percutaneous repair with suture anchor is less invasive,and more ben-eficial to functional recovery.

关 键 词：跟腱断裂 带线锚钉 微创手术 经皮缝合 

分 类 号：R686.1[医药卫生—骨科学]