鞘周膜通道下Achillon跟腱缝合导向器联合“回”字形缝合与跟腱后外侧切口Krachow缝合治疗KuwadaⅡ型急性闭合性跟腱断裂对比研究  

Comparative study of Achillon Achilles tendon suture guide combined with circuit suture via perineural channel and Krachow suture via posterolateral incision of Achilles tendon in treatment of Kuwada typeⅡacute closed Achilles tendon rupture

作　　者：汪松 李浩 唐金龙 朱正亚 刘勇 WANG Song;LI Hao;TANG Jinlong;ZHU Zhengya;LIU Yong(Department of Orthopedics,the Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu,221000,P.R.China)

机构地区：[1]徐州医科大学附属医院骨科,江苏徐州221000

出　　处：《中国修复重建外科杂志》2024年第12期1486-1491,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宿迁市指导性科技计划项目(Z202341);徐州医科大学附属医院自然科学项目(2021ZA26)。

摘　　要：目的比较鞘周膜通道下Achillon跟腱缝合导向器联合“回”字形缝合与跟腱后外侧切口Krachow缝合治疗KuwadaⅡ型急性闭合性跟腱断裂的疗效。方法回顾性分析2020年1月—2023年12月收治且符合选择标准的38例KuwadaⅡ型急性闭合性跟腱断裂患者临床资料。其中24例采用传统跟腱后外侧切口Krachow缝合法(传统组),14例采用鞘周膜通道下Achillon跟腱缝合导向器联合“回”字形缝合法(微创组)。两组患者年龄、性别、身体质量指数、致伤原因、受伤至手术时间、跟腱损伤特点(断端距离、残端长度)及术前跟腱完全断裂评分(ATRS)、美国矫形足踝协会(AOFAS)踝与后足功能评分等基线资料比较差异均无统计学意义(P>0.05)。记录两组患者手术时间、切口长度、住院时间及并发症(再撕裂、切口感染、腓肠神经激惹、深静脉血栓形成)发生情况。术前及术后3、6个月,采用ATRS评分和AOFAS踝与后足功能评分评价疗效。结果患者均顺利完成手术。微创组手术时间、切口长度及住院时间均明显小于传统组(P<0.05)。两组患者均获随访,随访时间8~16个月,平均12.7个月。两组均未出现腓肠神经损伤、跟腱二次断裂。传统组1例发生切口感染,1例因缝线出现排斥反应,1例出现肌间静脉血栓形成;微创组未出现切口愈合并发症、术区线结不适感及血栓形成。两组并发症发生率比较差异无统计学意义(P=0.283)。术后两组ATRS评分及AOFAS踝与后足功能评分有改善趋势,但差异无统计学意义(P>0.05)。除术后6个月两组AOFAS踝与后足功能评分比较差异无统计学意义(P>0.05)外,术后其余时间点微创组ATRS评分及AOFAS踝与后足功能评分均优于传统组(P<0.05)。结论鞘周膜通道下Achillon跟腱缝合导向器联合“回”字形缝合治疗KuwadaⅡ型急性闭合性跟腱断裂可获得与传统手术相似的足踝功能,但是切口更小且感染率低,利于患Objective To compare the effectiveness of Achillon Achilles tendon suture guide combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada typeⅡacute closed Achilles tendon rupture.Methods The clinical data of 38 patients with Kuwada typeⅡacute closed Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed.Krachow suture via posterolateral incision was used in 24 cases(traditional group),and Achillon Achilles tendon suture guide combined with circuit suture via perineural channel was used in 14 cases(minimally invasive group).There was no significant difference in baseline data such as age,gender,body mass index,cause of injury,time from injury to operation,characteristics of Achilles tendon injury(broken end distance,stump length),and preoperative Achilles tendon total rupture score(ATRS),American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score between the two groups(P>0.05).The operation time,incision length,hospital stay,and complications(re-tear,incision infection,sural nerve irritation,deep venous thrombosis)were recorded.ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation.Results All patients successfully completed the operation.The operation time,incision length,and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group(P<0.05).Patients in both groups were followed up 8-16 months,with an average of 12.7 months.There was no sural nerve injury or re-tear of Achilles tendon in both groups.In the traditional group,1 case had incision infection,1 case had suture rejection,and 1 case had intermuscular venous thrombosis;in the minimally invasive group,no incision healing complication,suture knot discomfort,or thrombosis occurred.There was no significant difference in the inci

关 键 词：跟腱断裂 Achillon跟腱缝合导向器 微创修复 

分 类 号：R687.2[医药卫生—骨科学]