改良微创技术修复急性闭合性跟腱断裂

A modified minimally invasive repair of acute closed Achilles tendon rupture

摘要:

[目的] 介绍改良微创技术修复急性闭合性跟腱断裂的手术技术和初步临床效果。[方法] 2018 年 1 月—2020 年 1 月应用改良微创技术修复急性闭合性跟腱断裂 35 例。于跟腱断端顶部皮肤做长约 1.0~1.5 cm 正中纵行切口，U 形钳抓取并牵出跟腱近断端，跖屈踝关节，利用空心手柄抓取并牵出跟腱远断端；利用改良 Bunnell 法缝合修复跟腱断端。修复撕裂的腱周组织，缝合切口。[结果]所有患者均顺利完成手术，手术时间(33.14±3.51)min，切口长度(2.33±0.44)cm，切口均 I 期愈合。患者均获随访，平均随访时间 (12.52±1.41) 个月。末次随访，踝背伸活动度、跖屈活动度均较术前显著增加 (P＜0.05)， AOFAS 踝-后足评分(92.62±2.73)分，Amer-Lindholm 标准评估，足踝功能优 29 例，良 6 例，优良率 100%。[结论]应用改良微创技术修复急性闭合性跟腱断裂具有切口小、并发症少、功能恢复好、治疗费用低的优点。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of a modified minimally invasive repair of acute closed Achilles tendon rupture. [Methods] From January 2018 to January 2020, 35 patients underwent modified minimally invasive repair of acute closed Achilles tendon rupture. A median longitudinal incision about 1.0~1.5 cm in length was made at the top of the broken Achilles tendon. The proximal end of Achilles tendon was pulled out with a U-shaped oval forceps and then the distal end of Achilles ten- don was pulled out at plantar flexion of the anklet. The modified Bunnell suture technique was used to repair the broken Achilles tendon, and then the torn peritendinous tissue sutured, the incision closed in layers. [Results] All the patients had operation performed smoothly with operation time of (33.14±3.51) min, total incision length of (2.33±0.44) cm, and excellent incision healing. At the latest follow up last- ed for (12.52±1.41) months, the plantar-dorsal flexion range of motion significantly increased compared with that before operation, with AO- FAS score of (92.62±2.73) . According to Amer-Lindholm criterion, the clinical outcomes were marked as excellent in 29 cases, good in 6 cases, with excellent and good rate of 100%. [Conclusion] This modified minimally invasive repair of acute closed Achilles tendon rupture has the advantages of small incision, fewer complications, good functional recovery and low treatment cost.