卵圆钳辅助小切口治疗急性跟腱断裂

Oval forceps assisted repair of acute Achilles tendon rupture through a small incision

摘要:

［目的］介绍卵圆钳辅助小切口治疗急性跟腱断裂的手术技术和初步临床结果。［方法］本院使用这种技术治疗急性跟腱断裂患者 23 例。术中触及断端，行纵向小切口， 用卵圆钳分别深入近侧与远侧腱鞘，夹持跟腱断端，腰穿针经皮穿过跟腱和卵圆钳，从对侧穿出皮外，然后将缝线穿过腰穿针，于不同平面各缝合 3 针，所有缝线置入成功后，抽出卵圆钳，将缝线两端引入小切口。跖屈位，使跟腱断端对合，打结完成缝合， 最后闭合小切口。［结果］所有患者均顺利手术，均无腓肠神经损伤。手术时间 （42.82±6.88） min。所有患者伤口均一期愈合。术后均无跟腱再断裂。AOFAS 评分由术后 3 个月 （91.57± 4.22）分，增加至术后 6 个月的（97.22±2.32）分；ROM 由术后 3 个月（32.57±2.46）°增加至术后 6 个月（43.13±2.94）°。［结论］卵圆钳辅助小切口治疗急性跟腱断裂的技术微创、安全、可靠，并易于学习。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of oval forceps assisted repair of acute Achilles tendon rupture through a small incision. [Methods] A total of 23 patients underwent abovementioned surgical treatment for acute Achilles tendon in our hospital. During operation, the ruptured gap was located by palpation, and a small longitudinal incision was made. An oval forceps was inserted into the tendon sheath through the incision to catch the ruptured ends proximally and distally respectively. Spi- nal needles were placed percutaneously to penetrate the tendons between the oval holes of the forceps on both sides to the opposite side. Af- ter that, sutures were introduced through the spinal needles and the needles were removed. As the forceps was pull out, the sutures were in- troduced out the incision. The ankle was placed plantar flexion extremely, the ends of ruptured Achilles tendon were closed to each other, and then corresponding sutures were tied to finish the repairing. Finally, the incision was closed in layers. [Results] All patients had opera- tion performed successfully without sural never injury intraoperatively, with operation time of (42.82±6.88) min. The incisions healed well in all the patients, whereas no re-rupture of tendon happened in anyone of them during the follow-up period. The AOFAS score increased from (91.57±4.22) at 3 months to (97.22±2.32) at 6 months postoperatively, while the ankle flexion-extension range of motion increased from (32.57±2.46)° at 3 months to (43.13±2.94)° at 6 months postoperatively. [Conclusion] This oval forceps assisted repair of acute Achil- les tendon rupture through a small incision is minimally invasive, safe, reliable and easy to learn.