镜下修复急性闭合性跟腱断裂△

Arthroscopic repair of acute closed Achilles tendon rupture

摘要:

［目的］介绍镜下近端套索缝合联合跟骨锚钉技术修复急性闭合性跟腱断裂手术技术及初步临床效果。［方法］2018 年 6 月—2019 年 1 月采用上述技术治疗急性闭合性跟腱断裂 19 例。在关节镜监视下使用 2#高强度缝线套索缝合跟腱断端近侧内外侧，将缝线尾端经腱周膜深面引导至跟骨结节两侧，使用直径 4.5 mm 的外排锚钉固定缝线尾端，逐步收紧缝线固定。［结果］19 例患者均顺利完成手术，术中无神经、血管损伤等严重并发症。所有患者均获 2 年以上随访，末次随访，跟腱完全断裂评分（Achiles tendon total rupture score, ATRS）（96.89±4.17）分；AOFAS 踝关节-后足评分（American Orthopeclic Foot and Ankle So- ciety, AOFAS）为（96.11±5.02）分；VAS 评分（visual analogue scale, VAS）为（0.39±0.50）分。所有患者均在术后 6 个月左右恢复到伤前的体育活动水平。［结论］ 此镜下技术治疗急性闭合性跟腱断裂，既能确保跟腱断端对合的质量和强度，又最大限度地避免了腓肠神经损伤，2 年临床疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of arthroscopic proximal lasso suture com- bined with calcaneal anchor for repair of acute closed Achilles tendon rupture. [Methods] From June 2018 to January 2019, 19 patients were treated with the above techniques for acute closed Achilles tendon rupture. Under arthroscope, the medial and lateral sides of the proximal Achilles tendon were sutured with 2# high-strength suture lasso, and the tail end of the suture was introduced to the two anchors 4.5mm in di- ameter on calcaneal tubercle under deep peritendinous membrane. The sutures were gradually tightened to pull the proximal end meet the dis- tal end of the tendon and fixed. [Results] All the 19 patients had operation performed successfully without serious complications such as neuro- vascular injury, and were followed up for more than 2 years. At the last follow-up, the ATRS score was of (96.89±4.17) . AOFAS ankle-hind- foot score of (96.11±5.02) , and the VAS score of (0.39±0.50) . All patients returned to their pre-injury level of physical activity about 6 months after surgery. [Conclusion] This arthroscopic technique for treatment of acute closed Achilles tendon rupture not only ensures the quality and strength of the tendon repair, but also avoid sural nerve injury to the maximum extent with satisfactory clinical outcomes.