改良Ma-Griffith 经皮与开放缝合急性跟腱断裂比较

Modified Ma- Griffith percutaneous repair versus open repair of acute Achilles tendon rupture

摘要:

[目的] 比较经皮修复与开放修复治疗急性闭合性跟腱断裂的临床效果。[方法] 回顾性研究2015 年7 月—2020 年2 月于本院手术治疗的急性闭合性跟腱断裂72 例患者的临床资料。根据医患沟通结果，38 例改良Ma-Griffith 经皮修复（微创组），另外34 例采用传统开放修复（开放组）。比较两组围手术期和随访资料。[结果] 微创组手术时间[(45.5±5.9) min vs (49.0±7.0) min , P＜0.05]、切口总长度[(5.5±0.8) cm vs (7.9±0.9) cm , P＜0.05]、术中失血量[(16.1±4.1) ml vs (25.9±4.9) ml , P＜0.05]、下地行走时间[(4.0±1.6) d vs (7.0±1.7) d , P＜0.05]、切口愈合等级[甲/乙/丙, 38/0/0 vs 30/4/0, P＜0.05]、住院时间[(8.2±1.9) d vs (12.0±2.5) d , P＜0.05] 均显著优于开放组。微创组腓肠神经损伤发生率显著高于开放组（20.1% vs 2.9%, P＜0.05），但微创组术后切口感染发生率显著低于开放组（0.0% vs 11.8%, P＜0.05）。所有患者平均随访（15.9 ±2.8） 个月，微创组术后完全负重活动时间显著早于开放组[(59.3±4.7) d vs (87.8±4.4) d, P＜0.05]。随术后时间推移，两组VAS 评分显著减小（P＜0.05），而AOFAS 评分及踝关节活动度显著增加（P＜0.05）。在术后1 个月，微创组的VAS [(1.9±0.6) vs (3.9±0.8), P＜0.05]、AOFAS [(86.0±3.4) vs (74.7±5.0),P＜0.05]、ATRS 评分[(89.2±4.0) vs (77.2±4.0), P＜0.05] 及踝关节活动度[(48.7±3.6)° vs (39.7±4.1) °, P＜0.05] 均显著优于开放组（P＜0.05），但是，末次随访时两组间上述指标的差异均无统计学意义（P＞0.05）。[结论] 经皮修复术作为一种微创手术，虽然腓肠神经损伤的风险较高，但与开放修复术相比，能明显降低跟腱断裂后的感染率，促进术后早期功能恢复。

Abstract:

[Objective] To compare the clinical outcomes of modified Ma-Griffith percutaneous repair (PR) versus conventional openrepair (OR) of acute closed Achilles tendon rupture. [Methods] A retrospective study was conducted on 72 patients who received surgicaltreatment for acute closed Achilles tendon rupture in our hospital from July 2015 to February 2020. Based on the results of doctor-patientcommunication, 38 patients underwent PR, while the other 34 patients received conventional open repair (OR). The perioperative periodand follow-up data of the two groups were compared. [Results] The PR group proved significantly superior the OR group in terms of opera-tion time [(45.5±5.9) min vs (49.0±7.0) min, P＜0.05], the total length of incision [(5.5±0.8) cm vs (7.9±0.9) cm, P＜0.05], intraoperativeblood loss [(16.1±4.1) ml vs (25.9±4.9) ml, P＜0.05], postoperative ambulation time [(4.0±1.6) days vs (7.0±1.7) days, P＜0.05], incision heal-ing grade [A/B/C, (38/0/0) vs (30/4/0), P＜0.05] and hospital stay [(8.2±1.9) days vs (12.0±2.5) days, P＜0.05]. The PR group got significantlyhigher incidence of sural nerve injury than the OR group (20.1% vs 2.9%, P＜0.05), whereas the former had significantly lower incidence ofpostoperative incision infection than the latter (0.0% vs 11.8%, P＜0.05). All patients were followed up for a mean of (15.9±2.8) months, andthe PR group resumed full weight-bearing activity significantly earlier than the OR group [(59.3±4.7) days vs (87.8±4.4) days, P＜0.05]. TheVAS score decreased significantly (P＜0.05), while AOFAS score and ankle range of motion (ROM) increased significantly in both groupsover time postoperatively (P＜0.05). The PR group proved significantly superior to the OR group in terms of VAS score [(1.9±0.6) vs (3.9±0.8), P＜0.05], AOFAS [(86.0±3.4) vs (74.7±5.0), P＜0.05], ATRS score [(89.2±4.0) vs (77.2±4.0), P＜0.05] and ankle ROM [(48.7±3.6)° vs(39.7±4.1)°, P＜0.05] 1 month postoperatively, whereas which became not statistically significant between the two groups at the latest followup (P＞0.05). [Conclusion] Compared with open repair, the percutaneous repair, a minimally invasive surgery, does significantly reduce theinfection rate after Achilles tendon rupture and improve the early postoperative functional recovery, despite of higher risk of sural nerve in-jury.