硬膜外穿刺针辅助穿线经跟骨骨隧道治疗跟腱断裂  

Epidural needle assisted transcalcaneal tunnel for the treatment of Achilles tendon rupture

作　　者：吴信举 谢久虎 汤浩 唐怀龙 周兴 朱自强 WU Xinju;XIE Jiuhu;TANG Hao(Department of Hand Surgery,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221006,China)

机构地区：[1]徐州医科大学第二附属医院手外科,江苏徐州221006

出　　处：《实用手外科杂志》2023年第4期483-486,共4页Journal of Practical Hand Surgery

摘　　要：目的 探讨通过硬膜外穿刺针辅助穿线经跟骨骨隧道治疗跟腱断裂的临床疗效。方法 回顾性分析2017年1月-2021年1月应用硬膜外穿刺针经跟骨骨隧道引导缝线加固止点治疗的22例跟腱断裂病例。急性闭合跟腱断裂患者的切口于跟腱断裂皮肤空虚处上缘行2~3 cm横行小切口,二次跟腱断裂患者取原切口或后内侧纵行切口。通过硬膜穿刺针分别在跟腱断裂近端、远端及跟骨处建立辅助隧道,引导穿入跟腱缝合线,结合改良Bunnell缝合法将断裂跟腱缝合。结果 随访22例,随访时间9~14个月。术后切口全部一期愈合,无深部感染、肌腱粘连、二次断裂、腓肠神经激惹等严重并发症发生。术后9个月踝关节活动度:跖屈25°~45°,背伸15°~25°,美国矫形足踝协会踝与后足评分平均93(85~97)分,优16例,良6例,优良率100%;Amer-Lindholm疗效评价标准评价:优18例,良4例,优良率100%;恢复至伤前体育活动水平19例(86.3%),重返运动时间19~24周,平均21.6周。结论 采用硬膜外穿刺针经跟骨骨隧道引导缝线加固止点跟腱断裂,临床效果确切,并发症少,器材易得,操作简单,值得临床尤其是基层医院推广。Objective To investigate the clinical effect of epidural needle assisted transcalcaneal tunnel in the treatment of Achilles tendon rupture.Methods A retrospective analysis was conducted on 22 cases of Achilles tendon rupture treated with epidural puncture needle and calcaneal tunnel guided suture reinforcement from January 2017 to January 2021.For patients with acute closed Achilles tendon rupture,a small transverse incision of 2~3 cm was made at the upper edge of the skin void of Achilles tendon rupture;for patients with secondary Achilles tendon rupture,the original incision or posterolateral longitudinal incision was made.Auxiliary tunnels were established at the proximal,distal and calcaneal parts of the ruptured Achilles tendon with dural puncture needles for anesthesia to guide the insertion of the suture line and sutured the ruptured Achilles tendon with the modified Bunnell suture method.Results Twenty-two patients were followed up for 9-14 months.All the incisions healed in one stage after operation,and no serious complications such as deep infection,tendon adhesion,secondary fracture and sural nerve irritation occurred.Ankle range of motion 9 months after surgery:plantar flexion was about 25°-45°,dorsi extension was about 15°-25°,the average ankle and hindfoot score of American Orthopaedic Foot and Ankle Association was 93(85-97)points,16 cases were excellent,6 cases were good,and the excellent and good rate was 100%.According to the evaluation criteria of Amer-Lindholm,18 cases were excellent,4 cases were good,and the excellent and good rate was 100%.Nineteen cases(86.3%)recovered to the level of physical activity before injury,and the time of return to exercise was 19-24 weeks,with an average of 21.6 weeks.Conclusion The use of epidural puncture needle through the calcaneal tunnel guided suture to strengthen the rupture of the stopping Achilles tendon,has the precise,clinical effect less complications, is easy to obtain equipment, simple operation, worthy of clinical promotion, especially in grass

关 键 词：跟腱断裂 硬膜外穿刺针 跟骨骨隧道 

分 类 号：R687.3[医药卫生—骨科学]