截骨与止点重建治疗顽固性止点跟腱炎的比较  

Zadek osteotomy versus Achilles tendon insertion reconstruction for intractable insertional Achilles tendinitis

作　　者：李帅 杨鑫权 张言[2] 赵宏谋[2] 梁晓军[2] LI Shuai;YANG Xin-quan;ZHANG Yan;ZHAO Hong-mo;LIANG Xiao-jun(Xi'an Medical College,Xi'an,Shaanxi 710068,China;Department of Foot and Ankle Surgery,Red Cross Hospital,Xi'an Jiaotong University,Xi'an,Shaanxi 710054,China)

机构地区：[1]西安医学院,陕西西安710068 [2]西安交通大学附属红会医院足踝外科,陕西西安710054

出　　处：《中国矫形外科杂志》2024年第23期2133-2139,共7页Orthopedic Journal of China

基　　金：陕西省重点研发计划项目(编号:2022ZDLSF02-13);2017陕西省博士后科研项目资助课题(编号:2017BSHQYXMZZ13)。

摘　　要：【目的】比较Zadek截骨术与跟腱止点重建术治疗顽固性止点性跟腱炎的临床疗效。【方法】回顾性分析2019年8月--2023年4月,在本中心手术治疗的44例(47足)止点性跟腱炎患者的临床资料。根据医患沟通结果,截骨组18例(20足),重建组26例(27足)。比较两组患者围手术期、随访及影像结果。【结果】两组患者均顺利完成手术,截骨组手术时间【(50.8±11.7)min vs(65.4±25.0)min,P<0.001】、切口总长度【(4.7±0.7)cm vs(6.8±0.7)cm,P<0.001】、下地行走时间【(25.3±3.5)dvs(36.6±6.9)d,P<0.001】、住院天数【(4.9±0.8)d vs(7.0±2.5)d,P<0.001】均显著少于重建组。随访时间平均(26.2±11.8)个月。截骨组恢复完全负重活动时间【(10.9+1.0)d vs(15.3±0.9)d,P<0.001】显著早于重建组。术后两组VAS评分显著减少(P<0.05),A0FAS评分、VISA-A评分、Tegner评分、SF-12MCS评分、SF-12PCS评分均显著增加(P<0.05),末次随访,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时,两组骨赘、止点骨水肿、腱膜增厚、Fowler-Philip角均显著改善(P<0.05),末次随访时,重建组骨赘变化、腱膜增厚及FPA角均显著优于截骨组(P<0.05),但是,两组止点骨水肿的差异无统计学意义(P>0.05)。【结论】两组患者术后在疼痛、功能及整体生活质量方面均获得明显改善,临床疗效无显著差异。但Zadek截骨术具有创伤小、手术时间短及并发症少等优势。【Objective】To compare the clinical outcomes of Zadek osteotomy versusresection of the calcaneal prominence and Achilles tendon insertion reconstruction for intractable insertional Achilles tendinitis(IAT).【Methods】A retrospective study was done on 44 patients(47 feet)who underwent surgical treatment for intractable IAT in our department from August 2019 to April 2023.According to preoperative doctor-patient communication,18 patients(20 feet)received Zadek osteotomy(the osteotomy group),while other 26 patients(27 feet)under-went resection of the calcaneal prominence and Achilles tendon insertion reconstruction(the reconstruction group).The perioperative period,follow-up and imaging data were compared between the two groups.【Results】All patients in both groups had operation conducted success-fully.The osteotomy group was significantly superior to the reconstruction group in terms of the operation time【(50.8±11.7)min vs(65.4±25.0)min,P<0.001】,the total incision length【(4.7±0.7)cm vs(6.8±0.7)cm,P<0.001】,ambulation time【(25.3±3.5)days vs(36.6±6.9)days,P<0.001】,hospitalization days【(4.9±0.8)days vs(7.0±2.5)days,P<0.001】.The average follow-up time was of(26.2±11.8)months,and the osteotomy group regained full weight-bearing activity significantly earlier than the reconstruction group【(10.9±1.0)days vs(15.3+0.9)days,P<0.001】.The VAS score for pain significantly decreased(P<0.05),while AOFAS score,VISA-A score,Tegner score,SF-12 MCS score and SF-12 PCS score significantly increased in both groups after surgery(P<0.05).At the last follow-up,there were no statistically signifi-cant differences in the above indexes between the two groups(P>0.05).As for imaging,osteophyte,insertional bone edema,aponeurosis thickening and Fowler-Philip angle(FPA)were significantly improved in both groups at the last follow-up compared with those preoperative-ly(P<0.05).At the last follow-up,the osteotomy group was inferior to the reconstruction group regarding to osteophyte changes,aponeurosis thickenin

关 键 词：止点性跟腱炎 止点重建术 Zadek截骨术 手术治疗 

分 类 号：R686.1[医药卫生—骨科学]