半切开锁扣阻挡改良Krackow缝合跟腱断裂

Semi-invasive locking block modified Krackow suture for Achilles tendon rupture

摘要:

[目的] 评价半切开锁扣阻挡改良 Krackow （locking block modified Krackow, LBMK） 缝合治疗跟腱断裂的疗效。[方法] 回顾性分析本院 2020 年 1 月—2023 年 2 月手术治疗的 63 例跟腱断裂患者的临床资料。依据医患沟通结果，33 例采用半切开 LBMK 缝合，30 例采用常规 Krackow 缝合。对比两组围手术期、随访资料。[结果] 改良组手术时间 [(45.0±6.4) min vs (50.6±7.2) min, P=0.002]、切口长度 [(2.5±0.5) cm vs 6.8±1.0) cm, P＜0.001]、术中失血量 [(12.6.±3.2) mL vs (34.7±8.3) mL, P＜0.001]、 下地行走时间 [(4.3±0.8) d vs (6.5±1.2) d, P＜0.001]、住院时间 [(7.0±2.0) d vs (9.4±2.3) d, P＜0.001] 均显著少于常规组。随访时间平均 （22.0±5.4）个月，改良组完全负重活动时间 [(46.2±4.6) d vs (50.0±5.3) d, P＜0.001] 显著早于常规组，术后随时间推移，两组 VAS 评分、AOFAS 评分、ATRS 评分、足跖屈-背伸 ROM 及单足提踵次数均显著改善（P＜0.05）。术后 1 个月和 6 个月，改良组 VAS 评分 [(2.0±0.5) vs 3.4±1.0), P＜0.001; (1.0±0.3) vs (1.2±0.4), P=0.028]，AOFAS 评分 [(78.4±4.0) vs (74.3±3.8), P＜0.001; (89.2±3.6) vs (86.0± 3.2), P＜0.001]，ATRS 评分 [(80.3±4.5) vs (75.8±4.2), P＜0.001; (90.0±3.8) vs (87.7±4.0), P=0.023] 和单足提踵次数 [(9.6±2.0) 次/min vs (7.5±1.4) 次/min, P＜0.001; (25.4±4.2) 次/min vs (20.8±3.8) 次/min, P＜0.001] 均显著优于常规组。改良组术后 1 个月跟腱断端间隙 [(0.1±0.0) cm vs (0.3±0.1) cm, P＜0.001] 显著小于常规组。[结论] 半切开 LBMK 缝合治疗跟腱断裂疗效明确，且微创安全，能明显恢复踝关节功能。

Abstract:

[Objective] To evaluate the efficacy of locking block modified Krackow (LBMK) suture in the treatment of ruptured Achilles tendon. [Methods] A retrospective study was conducted on 63 patients who had Achilles tendon rupture repaired surgically in our hospital from January 2020 to February 2023. According to the doctor-patient communication, 33 patients underwent semi-incision LBMK suture, while other 30 patients underwent conventional Krackow suture. The perioperative period and follow-up data of the two groups were compared. [Results] The LBMK group proved significantly superior to the conventional group in terms of operation time [(45.0±6.4) min vs (50.6± 7.2) min, P=0.002], length of incision, [(2.5±0.5) cm vs (6.8±1.0) cm, P＜0.001], intraoperative blood loss [(12.6±3.2) mL vs (34.7±8.3) mL, P＜0.001], ambulation time [(4.3±0.8) days vs (6.5 ±1.2) days, P＜0.001] and hospital stay [(7.0±2.0) days vs(9.4±2.3) days, P＜0.001]. All patients in both groups were followed up for a mean of (22.0±5.4) months, and the LBMK group resumed full weight-bearing activity significantly earlier than the conventional group [(46.2±4.6) days vs (50.0±5.3) days, P＜0.001]. The VAS, AOFAS and ATRS scores, as well as flexionextension ROM and heel raise times of affected foot were significantly improved in both groups over time (P＜0.05). The LBMK group was significantly better than the conventional group regarding to VAS score [(2.0±0.5) vs (3.4±1.0), P＜0.001; (1.0±0.3) vs (1.2±0.4), P=0.028], AO- FAS score [(78.4±4.0) vs (74.3±3.8), P＜0.001; (89.2±3.6) vs (86.0±3.2), P＜0.001], ATRS score [(80.3±4.5) vs (75.8±4.2), P＜0.001; (90.0± 3.8) vs (87.7±4.0), P=0.023] and the heel raise times of affected foot [(9.6±2.0) times vs (7.5±1.4) times, P＜0.001; (25.4±4.2) times vs (20.8± 3.8) times, P＜0.001] at 1 month and 6 months after surgery. In addition, the LBMK group had significantly less gap of broken end of Achilles tendon than the conventional group one month after surgery [(0.1±0.0) cm vs (0.3±0.1) cm, P＜0.001]. [Conclusion] Semi-incision LBMK suture for the treatment of Achilles tendon rupture is an effective, minimally invasive and safe technique, and can significantly restore ankle function earlier.