优先切开腱鞘的全内镜下手术与传统开放手术治疗腓骨肌腱滑脱症的临床效果比较  

The efficiency of total endoscopic surgery with preferential incision of the tendon sheath and traditional open surgery for the treatment of peroneal tendondislocation

作　　者：李明[1,2] 李杨 殷睿[1] 桂鉴超 Li Ming;Li Yang;Yin Rui;Gui Jianchao(Department of Sports Medicine and Joint Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Joint Surgery,Nanjing Gaochun People's Hospital,Nanjing 211300,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)运动关节科,南京210006 [2]南京市高淳人民医院关节外科,南京211300

出　　处：《中华外科杂志》2024年第6期556-564,共9页Chinese Journal of Surgery

基　　金：国家自然科学基金(81672210);江苏省科教兴卫工程医学领军人才基金(LJ201106)。

摘　　要：目的比较优先切开腱鞘的全内镜下手术与传统开放手术治疗腓骨肌腱滑脱症的临床效果。方法本研究为回顾性队列研究。回顾性分析2016年7月至2020年6月南京医科大学附属南京医院运动关节科收治的45例腓骨肌腱滑脱症患者的临床资料。男性26例,女性19例,年龄(31.2±9.3)岁(范围:17~45岁)。其中行改良腓骨肌沟加深联合腱鞘修补术23例(传统手术组),行优先切开腱鞘的全内镜下腓骨肌沟加深联合腱鞘修补术22例(全内镜组)。收集患者围手术期资料,采用疼痛视觉模拟评分(VAS)、美国足踝外科协会踝与后足评分(AOFAS-AH)、踝关节跖屈-背伸活动度(ROM)、健康调查简表(SF)-36及自制患者满意度调查问卷对患者术后疗效进行全面评估。术后行影像学检查,观察术后腓骨沟加深情况和肌腱及腱鞘愈合情况。定量资料的组间比较采用独立样本t检验、Wilcoxon秩和检验,组内比较采用配对样本t检验、重复测量方差分析;分类资料的比较采用χ2检验、Mann-whitney U检验或Fisher确切概率法。结果两组患者的性别、年龄、病程、损伤侧别、损伤分型的差异无统计学意义(P值均>0.05)。全内镜组手术时间为(47.9±5.4)min,传统手术组为(47.2±6.3)min,差异无统计学意义(t=0.402,P=0.690)。全内镜组与传统手术组相比,切口长度[(2.2±0.4)cm比(6.0±0.4)cm;t=32.892,P<0.01]和住院时间[(4.0±1.7)d比(7.6±3.6)d;t=4.249,P<0.01]更短。患者均获得12个月以上随访,随访时间(19.2±3.9)个月(范围:12~24个月)。术后3个月及末次随访时,全内镜组患者的VAS、AOFAS-AH、SF-36评分及患者满意度评分均高于传统手术组(P值均<0.05)。术后3个月全内镜组患者ROM高于传统手术组[(62.14±1.46)°比(53.13±1.52)°;t=20.315,P<0.01],末次随访时两组ROM的差异无统计学意义[(63.18±1.10)°比(63.48±2.43)°;t=0.531,P=0.599]。影像学检查结果显示,全内镜组腓骨沟加深情况优于传统Objective To compare the outcomes between the patients of peroneal tendon dislocation treated by either total endoscopic surgery with preferential incision of the tendon sheath or traditional open surgery.Methods This is a retrospective cohort study.The clinical data of 45 patients with peroneal tendon dislocation were operated at the Department of Sports Medicine and Joint Surgery,Nanjing First Hospital from July 2016 to June 2020.There were 26 males and 19 females,aged(31.2±9.3)years(range:17 to 45 years).Among them,23 patients underwent open peroneal tendon groove deepening followed by tendon sheath repair(traditional open group),and the other 22 patients underwent similar operations but all-endoscopically with preferential incision of peroneal tendon sheath(total endoscopic group).The perioperative data of patients were collected,and pain visual analogue score(VAS)was used to evaluate the pain changes before and after surgery and during the follow-up period,and the American Orthopaedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH),range of motion(ROM),the MOS item short form health survey(SF)-36,and the homemade questionnaire of patient satisfaction were used to evaluate the patients′outcomes after the operation,and CT scan was carried out to observe the deepening of the fibular groove and MRI to observe the status of the peroneal tendon and sheath during the follow-up.Independent sample t test,Wilcoxon rank sum test were used for comparison of quantitative data between groups.Chi-square test,Mann-whitney U or Fisher exact test was used for comparison of classified data,respectively;repeated measure ANOVA and paired sample t test were used for comparison of quantitative data before and after surgery in groups.Results There was no statistically significant difference between the two groups of patients in terms of gender,age,disease duration,side of injury,and injury typing(all P>0.05).There was no significant difference between the two groups in terms of operation time((47.9±5.4)minutes vs.(47.2±6

关 键 词：肌腱病 腓骨 腓骨肌腱滑脱 关节镜 踝关节 腓骨肌腱 微创 肌腱镜 

分 类 号：R687.2[医药卫生—骨科学]