三种小切口缝合修复急性跟腱断裂的比较

Comparison of three small- incision suture methods for repair of acute Achilles tendon rupture

摘要:

[目的] 比较三种小切口修复急性闭合性跟腱断裂的临床效果。[方法] 回顾性分析 2016 年 1 月—2021 年 10 月在本院小切口缝合急性闭合性跟腱断裂的 98 例患者的临床资料。依据术前医患沟通结果，47 例采用 3 孔回形法，28 例采用 3 孔 Bunnell 法；23 例采用 6 孔 Bunnell 法。比较三组围手术期、随访资料。[结果]三组间患者手术时间、术中失血量、下地行走时间、切口愈合等级、住院时间的差异均无统计学意义 （P＞0.05）。3 孔法切口总长度明显短于 6 孔法 （P＜0.05）。3 孔回形组术后完全负重时间显著早于 3 孔 Bunnell、6 孔 Bunnell 组 （P＜0.05）。随时间推移，三组 VAS 评分均显著减少 （P＜0.05），而 AOFAS 评分、ATRS 评分、足跖屈-背伸 ROM 均显著增加 （P＜0.05）。术后 1 个月，三组间上述指标的差异均无统计学意义 （P＞0.05），但术后 6 个月时 3 孔回形组 AOFAS、ATRS 评分均显著优于 3 孔 Bunnell、6 孔 Bunnell 组 （P＜0.05），但三组足跖屈-背伸 ROM 的差异无统计学意义 （P＞0.05）。末次随访时，三组间上述指标的差异均无统计学意义 （P＞0.05）。随访过程中， 三组均无跟腱再断裂等并发症发生。[结论]急性闭合性跟腱断裂 3 种不同的缝合方法远期治疗效果相似，但 3 孔法回形法切口小，更利于跟腱功能的早期恢复。

Abstract:

[Objective] To compare the clinical outcomes of three small-incisions suture repairs of acute closed Achilles tendon rup- ture. [Methods] A retrospective study was conducted on 98 patients who received small-incision repair for acute closed Achilles tendon rupture in our hospital from January 2016 to October 2021. According to the results of preoperative doctor-patient communication, 47 pa- tients were treated with 3-incision simple suture (3ISS), 28 patients were treated with 3-incision Bunnell suture (3IBS), while the remain- ing 23 patients were with the 6-incision Bunnell suture (6IBS). The perioperative period and follow-up data of the three groups were com- pared. [Results] There were no significant differences in operation time, intraoperative blood loss, postoperative walking time, incision heal- ing grade and hospital stay among the three groups (P＜0.05). The 3ISS and 3IBS had significantly shorter total incision length than the 6IBS group (P＜0.05). The 3ISS group resumed full weight- bearing activity significantly earlier than the 3IBS and 6IBS groups (P＜0.05). The VAS scores decreased significantly (P＜0.05), while AOFAS score, ATRS score and plantar-dorsal flexion range of motion (ROM) signifi- cantly increased in all the 3 groups over time (P＜0.05). Although there was no significant difference in the abovesaid items among the three groups a month after operation (P＞0.05), the 3ISS group proved significantly superior to the 3IBS and 6IBS group in terms of the AOFAS and ATRS scores (P＜0.05), whereas not in plantar-dorsal flexion ROM at 6 months postoperatively (P＞0.05). However, there was no signifi- cant difference in the abovementioned indexes among the three groups at the last follow-up (P＞0.05). During the follow-up, no complica- tions such as Achilles tendon re- rupture occurred in anyone of the three groups. [Conclusion] Although the 3 different suture methods have similar long-term clinical outcomes on acute closed Achilles tendon rupture, the 3-incision simple suture is more conducive to the early recovery of Achilles tendon function with smaller incision.