改良經皮縫合法與開放縫合法修復新鮮閉合性跟腱斷裂的療效比較_《中國修復重建外科雜志》

作者：

初海坤 ^1,2 , 徐衍斌 ³ , 初海鵬 ⁴ , 徐亞軍 ⁵ , 周鳳吉 ¹ , 于欣 ¹ , 李慧 ¹ , 季曉風 ¹

1 吉林大學中日聯誼醫院骨科（長春，130000）;;
大慶油田總醫院 2 骨科，5 藥劑科;;
3 四平市第四人民醫院骨科;;
4 大慶龍南醫院婦產科;

關鍵詞：

閉合性跟腱斷裂改良經皮縫合法跟腱修復

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目的通過與開放縫合法比較，探討改良經皮縫合法修復新鮮閉合性跟腱斷裂的療效。方法 2006年1 月－ 2009 年10 月，收治50 例新鮮閉合性跟腱斷裂患者，根據治療方法不同分為兩組，22 例采用改良經皮縫合法治療（改良組），術中于跟腱兩側平行各作5 個孔，采用“之”字形方式縫合；28 例采用Kesller 縫合法治療（常規組）。兩組患者性別、年齡、受傷至手術時間等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。結果常規組術后1 例切口感染，1 例跟腱再斷裂，2 例切口瘢痕攣縮；改良組患者切口均Ⅰ期愈合，無并發癥發生。改良組手術時間為（38.7 ± 6.6）min，明顯短于常規組（52.3 ± 6.9）min（t= —12.29，P=0.00）；改良組術中失血量為（4.9 ± 2.0）mL，顯著低于常規組（40.7 ± 7.1）mL（t= —25.20，P=0.00）。兩組患者均獲隨訪，隨訪時間2 ～ 3 年，平均 29.9 個月。術后2 年應用美國矯形足踝協會（A OFAS）評分標準評定，改良組為（99.6 ± 1.0）分，常規組為（98.4 ± 3.0）分，差異無統計學意義（t=1.66，P=0.10）。結論與開放縫合法比較，改良經皮縫合法具有手術操作簡便、并發癥少、踝關節功能恢復快等優點，是治療新鮮閉合性跟腱斷裂的較好選擇之一。

引用本文： 初海坤,徐衍斌,初海鵬,徐亞軍,周鳳吉,于欣,李慧,季曉風. 改良經皮縫合法與開放縫合法修復新鮮閉合性跟腱斷裂的療效比較. 中國修復重建外科雜志, 2012, 26(6): 708-711. doi: 復制

1.	Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
2.	Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
3.	Cretnik A, Kosanovi? M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg, 2004, 43(2): 72-81.
4.	張國柱, 蔣協遠, 王滿宜. 有限切開腱周內縫合法治療新鮮閉合性跟腱斷裂. 山東醫藥, 2010, 50(44): 22-24.
5.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
6.	商曉軍, 朱亞平, 韋兆祥. 閉合性跟腱斷裂微創腱皮縫合的遠期療效觀察. 中國矯形外科雜志, 2007, 15(18): 1371-1373.
7.	Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg, 2006, 72(2): 179-183.
8.	Bosworth DM. Repair of defects in the tendo Achillis. J Bone Joint Surg (Am), 1956, 38-A(1): 111-114.
9.	Sato M, Maeda M, Kurosawa H, et al. Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci, 2000, 5(3): 256-267.
10.	Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
11.	Ajis A, Maffulli N. Management of acute tendo Achilles ruptures. Foot Ankle Surg, 2007, 13: 132-135.
12.	Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int, 2001, 22(7): 572-574.
13.	Costa ML, MacMillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
14.	Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop, 2005, 76(4): 597-601.
15.	Wada A, Kubota H, Akiyama T, et al. Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg (Am), 2001, 26(3): 398-406.

1. Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
2. Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
3. Cretnik A, Kosanovi? M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg, 2004, 43(2): 72-81.
4. 張國柱, 蔣協遠, 王滿宜. 有限切開腱周內縫合法治療新鮮閉合性跟腱斷裂. 山東醫藥, 2010, 50(44): 22-24.
5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
6. 商曉軍, 朱亞平, 韋兆祥. 閉合性跟腱斷裂微創腱皮縫合的遠期療效觀察. 中國矯形外科雜志, 2007, 15(18): 1371-1373.
7. Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg, 2006, 72(2): 179-183.
8. Bosworth DM. Repair of defects in the tendo Achillis. J Bone Joint Surg (Am), 1956, 38-A(1): 111-114.
9. Sato M, Maeda M, Kurosawa H, et al. Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci, 2000, 5(3): 256-267.
10. Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
11. Ajis A, Maffulli N. Management of acute tendo Achilles ruptures. Foot Ankle Surg, 2007, 13: 132-135.
12. Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int, 2001, 22(7): 572-574.
13. Costa ML, MacMillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
14. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop, 2005, 76(4): 597-601.
15. Wada A, Kubota H, Akiyama T, et al. Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg (Am), 2001, 26(3): 398-406.

《中國修復重建外科雜志》

改良經皮縫合法與開放縫合法修復新鮮閉合性跟腱斷裂的療效比較

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《中國修復重建外科雜志》

改良經皮縫合法與開放縫合法修復新鮮閉合性跟腱斷裂的療效比較

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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