半切开锁扣阻挡改良Krackow缝合跟腱断裂  

Semi-invasive locking block modified Krackow suture for Achilles tendon rupture

作　　者：徐梦瑶 田建 胡雨璇 张宇轩 XU Meng-yao;TIAN Jian;HU Yu-xuan;ZHANG Yu-xuan(The Ninth People's Hospital of Wuxi City,Wuxi,Jiangsu 214000,China)

机构地区：[1]无锡市第九人民医院,江苏无锡214000

出　　处：《中国矫形外科杂志》2025年第7期604-609,共6页Orthopedic Journal of China

摘　　要：[目的]评价半切开锁扣阻挡改良Krackow(locking block modified Krackow,LBMK)缝合治疗跟腱断裂的疗效。[方法]回顾性分析本院2020年1月—2023年2月手术治疗的63例跟腱断裂患者的临床资料。依据医患沟通结果,33例采用半切开LBMK缝合,30例采用常规Krackow缝合。对比两组围手术期、随访资料。[结果]改良组手术时间[(45.0±6.4)min vs(50.6±7.2)min,P=0.002]、切口长度[(2.5±0.5)cm vs(6.8±1.0)cm,P<0.001]、术中失血量[(12.6.±3.2)mL vs(34.7±8.3)mL,P<0.001]、下地行走时间[(4.3±0.8)d vs(6.5±1.2)d,P<0.001]、住院时间[(7.0±2.0)d vs(9.4±2.3)d,P<0.001]均显著少于常规组。随访时间平均(22.0±5.4)个月,改良组完全负重活动时间[(46.2±4.6)d vs(50.0±5.3)d,P<0.001]显著早于常规组,术后随时间推移,两组VAS评分、AOFAS评分、ATRS评分、足跖屈-背伸ROM及单足提踵次数均显著改善(P<0.05)。术后1个月和6个月,改良组VAS评分[(2.0±0.5)vs(3.4±1.0),P<0.001;(1.0±0.3)vs(1.2±0.4),P=0.028],AOFAS评分[(78.4±4.0)vs(74.3±3.8),P<0.001;(89.2±3.6)vs(86.0±3.2),P<0.001],ATRS评分[(80.3±4.5)vs(75.8±4.2),P<0.001;(90.0±3.8)vs(87.7±4.0),P=0.023]和单足提踵次数[(9.6±2.0)次/min vs(7.5±1.4)次/min,P<0.001;(25.4±4.2)次/min vs(20.8±3.8)次/min,P<0.001]均显著优于常规组。改良组术后1个月跟腱断端间隙[(0.1±0.0)cm vs(0.3±0.1)cm,P<0.001]显著小于常规组。[结论]半切开LBMK缝合治疗跟腱断裂疗效明确,且微创安全,能明显恢复踝关节功能。[Objective]To evaluate the efficacy of locking block modified Krackow(LBMK)suture in the treatment of ruptured Achilles tendon.[Methods]A retrospective study was conducted on 63 patients who had Achilles tendon rupture repaired surgically in our hospital from January 2020 to February 2023.According to the doctor-patient communication,33 patients underwent semi-incision LBMK suture,while other 30 patients underwent conventional Krackow suture.The perioperative period and follow-up data of the two groups were compared.[Results]The LBMK group proved significantly superior to the conventional group in terms of operation time[(45.0±6.4)min vs(50.6±7.2)min,P=0.002],length of incision,[(2.5±0.5)cm vs(6.8±1.0)cm,P<0.001],intraoperative blood loss[(12.6±3.2)mL vs(34.7±8.3)mL,P<0.001],ambulation time[(4.3±0.8)days vs(6.5±1.2)days,P<0.001]and hospital stay[(7.0±2.0)days vs(9.4±2.3)days,P<0.001].All patients in both groups were followed up for a mean of(22.0±5.4)months,and the LBMK group resumed full weight-bearing activity significantly earlier than the conventional group[(46.2±4.6)days vs(50.0±5.3)days,P<0.001].The VAS,AOFAS and ATRS scores,as well as flexionextension ROM and heel raise times of affected foot were significantly improved in both groups over time(P<0.05).The LBMK group was significantly better than the conventional group regarding to VAS score[(2.0±0.5)vs(3.4±1.0),P<0.001;(1.0±0.3)vs(1.2±0.4),P=0.028],AO-FAS score[(78.4±4.0)vs(74.3±3.8),P<0.001;(89.2±3.6)vs(86.0±3.2),P<0.001],ATRS score[(80.3±4.5)vs(75.8±4.2),P<0.001;(90.0±3.8)vs(87.7±4.0),P=0.023]and the heel raise times of affected foot[(9.6±2.0)times vs(7.5±1.4)times,P<0.001;(25.4±4.2)times vs(20.8±3.8)times,P<0.001]at 1 month and 6 months after surgery.In addition,the LBMK group had significantly less gap of broken end of Achilles tendon than the conventional group one month after surgery[(0.1±0.0)cm vs(0.3±0.1)cm,P<0.001].[Conclusion]Semi-incision LBMK suture for the treatment of Achilles tendon rupture is an effective,min

关 键 词：跟腱断裂 半切开 锁扣阻挡 改良Krackow缝合 

分 类 号：R687[医药卫生—骨科学]