急性跟腱断裂通道辅助微创吻合术后动态与静态康复模式的比较研究  

A comparative study of dynamic versus static rehabilitation protocols after acute Achilles tendon rupture repair with channel assisted minimally invasive repair technique

作　　者：王中鹤 孔令通 曹文豪 汤俊君 齐红哲 窦美静 刘浩宇 陈辰 陈华 WANG Zhonghe;KONG Lingtong;CAO Wenhao;TANG Junjun;QI Hongzhe;DOU Meijing;LIU Haoyu;CHEN Chen;CHEN Hua(Senior Department of Orthopedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing,100142,P.R.China;Graduate School,Ningxia Medical University,Yinchuan Ningxia,750004,P.R.China;Orthopedic Department Unit 1,the First Medical Center of Chinese PLA General Hospital,Beijing,100853,P.R.China)

机构地区：[1]中国人民解放军总医院第四医学中心骨科医学部,北京100142 [2]宁夏医科大学研究生院,银川750004 [3]中国人民解放军总医院第一医学中心骨科一病区,北京100853

出　　处：《中国修复重建外科杂志》2024年第12期1492-1498,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过前瞻性临床对比研究,探讨通道辅助微创吻合技术(channel assisted minimally invasive repair,CAMIR)吻合急性跟腱断裂术后动态与静态康复模式的疗效差异,以期为临床选择治疗方案提供参考。方法以2021年6月—2022年6月收治的急性跟腱断裂患者为研究对象,其中60例符合选择标准纳入研究。通过随机数字表法,将患者分成动态康复组和静态康复组(n=30)。两组患者性别、年龄、身体质量指数、吸烟史、受伤侧别、致伤原因及病程等基线资料比较,差异均无统计学意义(P>0.05)。CAMIR跟腱吻合手术后,动态康复组实施跟腱靴辅助下早期部分负重训练及踝关节控制性活动锻炼,持续6周;而静态康复组在此期间维持非负重状态。记录两组并发症发生情况。术后3、6个月采用跟腱完全断裂评分(ATRS)评价患肢跟腱功能受限程度;健康调查12项简表(SF-12量表)评价患者生活质量,包括躯体健康(PCS)和心理健康(MCS)两部分。结果两组术中均无腓肠神经损伤。术后患者均获随访,随访时间12~18个月,平均14个月。术后3、6个月,动态康复组ATRS评分均高于静态康复组(P<0.05)。术后3个月,动态康复组PCS评分、MCS评分以及SF-12总分均低于静态康复组,差异有统计学意义(P<0.05);术后6个月,两组上述评分差异均无统计学意义(P>0.05)。术后动态康复组2例(6.6%)、静态康复组5例(16.7%)发生并发症,发生率差异无统计学意义(P>0.05)。结论急性跟腱断裂患者CAMIR跟腱吻合术后采用动态康复模式,能在早期阶段显著促进患者功能恢复,安全性与临床效果与传统静态康复模式相似。Objective To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair(CAMIR)technique through a prospective comparative trial,aiming to provide a reference for clinically selecting a feasible treatment regimen.Methods Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study,with 60 patients meeting the selection criteria.They were randomly divided into a dynamic rehabilitation group(n=30)and a static rehabilitation group(n=30)using a computer-generated random number method.There was no significant difference in baseline data such as gender,age,body mass index,smoking history,injured side,cause of injury,and disease duration between the two groups(P>0.05).After Achilles tendon anastomosis by using CAMIR technique,the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks,while the static rehabilitation group maintained a non-weight-bearing status during this period.Complications in both groups were recorded.At 3 and 6 months after operation,the Achilles tendon total rupture score(ATRS)was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb,and the 12-Item Short Form Health Survey(SF-12 scale)was used to assess the patients’quality of life,including physical component summary(PCS)and mental component summary(MCS)scores.Results No sural nerve injury occurred during operation in both groups.All patients were followed up 12-18 months(mean,14 months).The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group(P<0.05).At 3 months after operation,the dynamic rehabilitation group had significantly lower PCS,MCS,and SF-12 total scores compared to th

关 键 词：急性跟腱断裂 动态康复模式 静态康复模式 微创手术 前瞻性研究 

分 类 号：R687.2[医药卫生—骨科学]