带线锚钉经皮与开放缝合急性跟腱断裂的比较△

Percutaneous repair with suture anchors versus open counterpart for acute Achilles tendon rupture

摘要:

[目的] 比较经皮与开放缝合治疗急性跟腱断裂的临床疗效。[方法] 回顾性分析2017 年10 月—2021 年10 月本院手术治疗的急性跟腱断裂35 例患者的临床资料，根据术前医患沟通结果，16 例采用带线锚钉闭合缝合（经皮组），19 例采用切开缝合（开放组）。比较两组围手术期、随访结果。[结果] 所有患者均顺利完成手术。经皮组手术时间[(56.6±10.4) min vs(81.7±28.7) min, P=0.003]、切口长度[(1.9±0.6) cm vs (7.7±3.5) cm, P＜0.001]、术中失血量[(10.6±6.0) ml vs (26.0±15.8) ml, P＜0.001]、住院时间[(8.2±1.6) d vs (11.1±3.5) d, P=0.015] 均显著优于开放组，而两组下地行走时间及切口愈合情况的差异均无统计学意义（P＞0.05）。随访时间平均（21.8±7.1） 个月，经皮组术后完全负重活动时间显著早于开放组[(8.4±1.0) 周vs (12.8±3.1)周, P=0.005]。术后随时间推移，两组患者VAS、AOFAS 和ATRS 评分，以及足跖屈-背伸ROM 均显著改善（P＜0.05）。经皮组术后1 个月[(1.6±0.4) vs (2.3±0.7), P=0.001] 和术后6 个月[(0.9±0.3) vs (1.3±0.4), P=0.004] 的VAS 均显著优于开放组，相应时间点，两组间AOFAS、ATRS 评分和足跖屈-背伸ROM 的差异均无统计学意义（P＞0.05）。[结论] 与切开缝合治疗相比，带线锚钉经皮缝合手术创伤小，更有利于功能恢复。

Abstract:

[Objective] To compare the clinical outcomes of percutaneous repair with suture anchors versus open counterpart for treat-ment of acute Achilles tendon rupture. [Methods] A retrospective study was done on 35 patients who received surgical repair for acuteAchilles tendon rupture in our hospital from October 2017 to October 2021. According to the preoperative doctor-patient communication,16 patients underwent percutaneous repair of the tendon with suture anchor (the percutaneous group), while the remaining 19 patient under-went conventional open repair (open group). The perioperative and follow-up documents were compared between the two groups. [Results]All patients had corresponding surgical procedures performed successfully. The percutaneous group was significantly superior to the opengroup in terms of operation time [(56.6±10.4) min vs (81.7±28.7) min, P=0.003], incision length [(1.9±0.6) cm vs (7.7±3.5) cm, P＜0.001], in-traoperative blood loss [(10.6±6.0) ml vs (26.0±15.8) ml, P＜0.001], hospital stay [(8.2±1.6) days vs (11.1±3.5) days, P=0.015], but there wasno statistical significance in the walking time and incision healing grade between the two groups (P＞0.05). The follow-up period lasted for(21.8±7.1) months in a mean, and the percutaneous group resumed full weight-bearing activity significantly earlier than the open group[(8.4±1.0) weeks vs (12.8±3.1) weeks, P=0.005]. The VAS, AOFAS and ATRS scores, as well as plantar flexion-dorsal extension ROM weresignificantly improved in both groups over time (P＜0.05). Percutaneous group was significantly better than that of the open group in VASscore at 1 month [(1.6±0.4) vs (2.3±0.7), P=0.001] and 6 months postoperatively [(0.9±0.3) vs (1.3±0.4), P=0.005], despite of insignificantdifferences in terms of AOFAS, ATRS scores and plantar flexion-dorsal extension ROM between the two groups at any time points accord-ingly (P＞0.05). [Conclusion] Compared with traditional open repair, percutaneous repair with suture anchor is less invasive, and more ben-eficial to functional recovery.