传统与微创缝合急性闭合性跟腱断裂的比较

Comparison of traditional and minimally invasive sutures for acute closed Achilles tendon tears

摘要:

［目的］比较传统与微创缝合术治疗修复急性闭合性跟腱断裂的临床效果。［方法］2016 年 5 月—2019 年 11 月，对 64 例（64 足）急性闭合性跟腱断裂患者行手术缝合修复术。依据术前医患沟通结果，30 例行传统切开缝合术，34 例行通道辅助微创修复系统（channel-assisted minimally invasive repair, CAMIR）缝合术。比较两组围手术期、随访和影像资料。［结果］微创组手术时间 ［（56.40±4.21） min vs （78.24±8.75） min，P<0.05］、切口长度 ［（3.75±0.50） cm vs （12.90±1.77） cm，P< 0.05］和术中出血量 ［（12.29±1.75）ml vs（24.5±2.92）ml，P<0.05］均显著优于传统组。术后随访（23.80±3.75）个月。与术前相比，末次随访时两组 VAS 评分显著减少 （P<0.05），而 AOFAS 和 ATRS 评分显著增加 （P<0.05）。至末次随访时，微创组的 VAS 评分 ［（0.99±0.30） vs （1.34±0.28），P<0.05］ 和 AOFAS 评分 ［（81.15±3.28） vs （77.27±2.21），P<0.05］ 均显著优于传统组，但两组间 ATRS 评分的差异无统计学意义（P>0.05）。［结论］与传统切开缝合术相比，CAMIR 微创缝合具有创伤小、 术后功能恢复更好的的优势。

Abstract:

[Objective] To compare the clinical efficiency of traditional and minimally invasive sutures for acute closed Achilles tendon rupture. [Methods] From May 2016 to November 2019, 64 patients (64 feet) underwent surgical repair for acute closed Achilles tendon rup- ture in our hospitals. According to the results of preoperative doctor-patient communication, 30 patients were treated with traditional open suture, while the other 34 patients had the tendon sutured by channel-assisted minimally invasive repair (CAMIR) . The perioperative, fol- low-up and imaging documents were compared between the two groups. [Results] The CAMIR group proved significantly superior to the traditional group regarding to operation time [ (56.40±4.21) min vs (78.24±8.75) min, P＜0.05] , incision length [ (3.75±0.50) cm vs (12.90± 1.77) cm, P＜0.05] and intraoperative blood loss [ (12.29±1.75)ml vs (24.5±2.92) ml, P＜0.05] . The postoperative follow-up period lasted for (23.80±3.75) months on average. The VAS scores decreased significantly (P＜0.05) , while the AOFAS and ATRS scores increased sig- nificantly in both groups at the latest follow-up compared with those before operation (P＜0.05) . At the latest follow-up, the CAMIR group was significantly better than the traditional group in terms of VAS score [ (0.99±0.30) vs (1.34±0.28) , P＜0.05] and AOFAS score [ (81.15± 3.28) vs (77.27±2.21) , P＜0.05] , nevertheless there was no a statistically significant difference in ATRS scores between the two groups (P＞ 0.05) . [Conclusion] Compared with traditional open suture, the minimally invasive suture by using CAMIR has the advantages of less trau- ma and better postoperative functional recovery.