截骨与止点重建治疗顽固性止点跟腱炎的比较△

Zadek osteotomy versus Achilles tendon insertion reconstruction for intractable insertional Achilles tendinitis

摘要:

[目的]比较Zadek截骨术与跟腱止点重建术治疗顽固性止点性跟腱炎的临床疗效。[方法]回顾性分析2019年8 月—2023年4月，在本中心手术治疗的44例（47足）止点性跟腱炎患者的临床资料。根据医患沟通结果，截骨组18例（20 足），重建组26例（27足）。比较两组患者围手术期、随访及影像结果。[结果]两组患者均顺利完成手术，截骨组手术时间 [(50.8±11.7)minvs(65.4±25.0)min,P＜0.001]、切口总长度[(4.7±0.7)cmvs(6.8±0.7)cm,P＜0.001]、下地行走时间[(25.3±3.5)dvs (36.6±6.9)d,P＜0.001]、住院天数[(4.9±0.8)dvs(7.0±2.5)d,P＜0.001]均显著少于重建组。随访时间平均（26.2±11.8）个月。截骨组恢复完全负重活动时间[(10.9±1.0)dvs(15.3±0.9)d,P＜0.001]显著早于重建组。术后两组VAS评分显著减少（P＜0.05），AOFAS评分、VISA-A评分、Tegner评分、SF-12MCS评分、SF-12PCS评分均显著增加（P＜0.05），末次随访，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时，两组骨赘、止点骨水肿、腱膜增厚、Fowler-Philip角均显著改善 （P＜0.05），末次随访时，重建组骨赘变化、腱膜增厚及FPA角均显著优于截骨组（P＜0.05），但是，两组止点骨水肿的差异无统计学意义（P＞0.05）。[结论]两组患者术后在疼痛、功能及整体生活质量方面均获得明显改善，临床疗效无显著差异。但Za- dek截骨术具有创伤小、手术时间短及并发症少等优势。

关键词:止点性跟腱炎;止点重建术;Zadek截骨术;手术治疗

Abstract:

[Objective] To compare the clinical outcomes of Zadek osteotomy versusresection of the calcaneal prominence and Achilles

tendon insertion reconstruction for intractable insertional Achilles tendinitis (IAT). [Methods] A retrospective study was done on 44 patients

(47 feet) who underwent surgical treatment for intractable IAT in our department from August 2019 to April 2023. According to preoperative

doctor-patient communication, 18 patients (20 feet) received Zadek osteotomy (the osteotomy group), while other 26 patients (27 feet) under-

went resection of the calcaneal prominence and Achilles tendon insertion reconstruction (the reconstruction group). The perioperative period,

follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation conducted success-

fully. The osteotomy group was significantly superior to the reconstruction group in terms of the operation time [(50.8±11.7) min vs (65.4±

25.0) min, P<0.001], the total incision length [(4.7±0.7) cm vs (6.8±0.7) cm, P<0.001], ambulation time [(25.3±3.5) days vs (36.6±6.9) days,

P<0.001], hospitalization days [(4.9±0.8) days vs (7.0±2.5) days, P<0.001]. The average follow-up time was of (26.2±11.8) months, and the

osteotomy group regained full weight-bearing activity significantly earlier than the reconstruction group [(10.9±1.0) days vs (15.3±0.9) days,

P<0.001]. The VAS score for pain significantly decreased (P<0.05), while AOFAS score, VISA-A score, Tegner score, SF-12 MCS score

and SF-12 PCS score significantly increased in both groups after surgery (P<0.05). At the last follow-up, there were no statistically signifi-

cant differences in the above indexes between the two groups (P>0.05). As for imaging, osteophyte, insertional bone edema, aponeurosis

thickening and Fowler-Philip angle (FPA) were significantly improved in both groups at the last follow-up compared with those preoperative-

ly (P<0.05). At the last follow-up, the osteotomy group was inferior to the reconstruction group regarding to osteophyte changes, aponeurosis

thickening and FPA (P<0.05), but there was no significant difference in bone edema between the two groups (P>0.05). [Conclusion] Both

procedures achieve similar clinical consequence in terms of pain relief, and improvement of function and overall quality of life. By compari-son, the Zadek osteotomy has the advantages of less trauma, shorter operation time and fewer complications over the tendon insertion recon-

struction.

Key words:insertional Achilles tendinitis; Achilles tendon insertion reconstruction; Zadek osteotomy; surgical treatment