急性闭合性跟腱断裂经皮微创修复术后关节僵硬与踝关节功能预后的危险因素分析  

Risk factors of joint stiffness and ankle joint function prognosis after percutaneous minimally invasive repair of acute closed Achilles tendon rupture

作　　者：张宁[1] 刘亦斌 闫玮琪 康志学 刘飞[1] ZHANG Ning;LIU Yibin;YAN Weiqi;KANG Zhixue;LIU Fei(Department of Hand,Foot,and Ankle Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院手足踝外科,银川750004

出　　处：《中华骨与关节外科杂志》2023年第12期1094-1099,共6页Chinese Journal of Bone and Joint Surgery

基　　金：宁夏自然科学基金项目计划任务书(2022AAC3610)。

摘　　要：目的:分析急性闭合性跟腱断裂经皮微创修复术后关节僵硬与踝关节功能预后的危险因素。方法:回顾性分析2019年1月至2022年1月接受经皮微创修复术治疗的120例急性闭合性跟腱断裂患者的病例资料,根据Arner-Lindholm评定法评估术后预后情况,将其分为预后良好组(90例)和预后不良组(30例),探究急性闭合性跟腱断裂患者术后关节僵硬与踝关节功能改善情况。应用单因素分析及多因素logistic回归分析探究急性闭合性跟腱断裂患者术后预后情况的主要危险因素。结果:单因素分析显示急性闭合性跟腱断裂患者术后预后不良情况发生与性别、年龄、断裂位置、损伤范围、踝关节积液情况无关(P>0.05);主要与断端间隙、伤口感染、并发踝关节骨折、术后外固定时间、术后负重时间、延迟治疗、腓肠神经损伤、再断裂的情况有关(P<0.05)。以急性闭合性跟腱断裂患者术后预后情况为因变量,选取单因素分析中P<0.05的变量作为自变量,行多因素logistic回归分析,结果发现,并发踝关节骨折、断端间隙、延迟治疗、伤口感染、再断裂、术后负重时间、腓肠神经损伤、术后外固定时间为急性闭合性跟腱断裂患者术后发生预后不良情况的主要因素(P<0.05)。与术后1个月相比,术后3个月患者的踝关节活动度、踝关节跖屈肌力、跟腱长度、跟腱完全断裂评分(ATRS)、美国足踝外科协会(AOFAS)踝-后足评分有所提升;与术后3个月相比,术后7个月患者的踝关节活动度、跟腱长度、踝关节跖屈肌力、AOFAS评分、ATRS评分显著上升(P<0.05)。结论:通过经皮微创修复术对急性闭合性跟腱断裂进行干预,可有效改善患者踝关节功能,缓解跟腱活动度。并发踝关节骨折、延迟治疗、腓肠神经损伤、断端间隙、伤口感染、再断裂、术后负重及外固定时间为患者预后不良情况发生的主要危险因素。Objective:To analyze the risk factors of joint stiffness and ankle joint function prognosis after percutaneous minimally invasive repair of acute closed Achilles tendon rupture.Methods:A retrospective analysis was conducted on the medical records of 120 patients with acute closed Achilles tendon rupture who received percutaneous minimally invasive repair from January 2019 to January 2022.The postoperative outcomes were evaluated using Arner-Lindholm evaluation method,which classified patients into a good prognosis group(90 cases)and a poor prognosis group(30 cases).The investigation aimed to explore the improvement in joint stiffness and ankle joint function after surgery in patients with acute closed Achilles tendon rupture.The main risk factors for postoperative prognosis in patients with acute closed Achilles tendon rupture were explored using univariate analysis and multivariate Logistics regression analysis.Results:Univariate analysis showed that the poor postoperative prognosis of patients with acute closed Achilles tendon rupture was not related to gender,age,fracture location,injury range,or ankle joint effusion(P>0.05).However,it was significantly related to fracture gap,wound infection,concurrent ankle joint fracture,postoperative external fixation duration,postoperative weight-bearing duration,delayed treatment,sural nerve injury,and re-rupture(P<0.05).With the postoperative prognosis of patients with acute closed Achilles tendon rupture as the dependent variable,variables with P<0.05 in univariate analysis were selected as independent variables for multivariate logistic regression analysis.The results showed that concurrent ankle joint fracture,fracture gap,delayed treatment,wound infection,re-rupture,postoperative weight-bearing duration,sural nerve injury,and postoperative external fixation duration were the major factors associated with poor postoperative prognosis in patients with acute closed Achilles tendon rupture(P<0.05).Compared to 1 month postoperatively,patients at 3 months postoperatively

关 键 词：急性闭合性跟腱断裂 经皮微创修复术 关节僵硬 踝关节功能 

分 类 号：R683.4[医药卫生—骨科学]