双津下套圈缝合法与跟腱龙技术治疗急性跟腱断裂的比较
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摘要
[目的]为比较两种微创手术治疗急性跟腱断裂的临床结果。[方法]共计140例患者纳入本研究,其中101例采用津下技术,39例采用跟腱龙技术修复跟腱。记录手术时间、住院天数、并发症等情况,并采用AOFAS踝-后足疗效评价及ATRS跟腱断裂评分评定术后疗效。[结果]津下组手术时间及住院天数短于跟腱龙组,差异有统计学意义(P<0.05)。津下组患者总体并发症发生率为1%,仅有1例再断裂,无感染、腓肠神经损伤、皮肤粘连等并发症。跟腱龙组术后总体并发症发生率为10%,其中,腓肠神经损伤1例,切口感染1例,跟腱粘连1例,1例术后1个半月因肺栓塞去世。138例患者获得随访,随访时间6个月～3年。两组患者ATRS和AOFAS评分均随时间延长而增高,并且不同时间点差异有统计学意义(P<0.05)。术后6月和术后1年时,津下组评分较跟腱龙组评分高(P<0.05),术后3年时,津下组评分与跟腱龙组评分差异无统计学意义(P>0.05)。[结论]小切口双津下缝合法和跟腱龙手术均为微创手术,具有切口小、愈合快、并发症少等优点。与跟腱龙手术相比,小切口双津下套圈缝合法术后早期效果更好。
[Objective] To compare the clinical outcomes of double-Tsuge loop suture versus Achillon for mini-incision repair of acute Achilles tendon rupture. [Methods] A total of 140 persons were enrolled into this study. Of them, 101 patients had the Achilles tendon repaired by the double-Tsuge loop technique, while the remaining 39 patients had the tendon repaired by Achillon technique. The operation time, hospital stay and complications were recorded for comparison between the two groups.In addition, the Achilles tendon Total Rupture Score(ATRS) and AOFAS ankle-hind foot score were used for evaluation of the clinical consequences. [Results] The patients in the Tsuge group consumed significantly less operation time, associated with significantly shorter hospital stay than those in the Achillon group(P<0.05). The total complication rate proved of 1% in the Tsuge group, whereas 10% in the Achillon group, including only 1 re-rupture of the tendon in the Tsuge group, whereas 1 sural nerve injury, 1 incision infection, 1 shin adhesion and 1 patient died of pulmonary embolism 2 weeks after operation in the Achillon group. Among the patients, 138 were followed up from 6 months to 3 years. Both the ATRS and AOFAS scores significantly increased in the two groups as time went on postoperatively(P<0.05). The Tsuge group proved significantly superior to the Achillon group regarding to ATRS and AOFAS scores at 6 months and 1 year postoperatively(P<0.05), despite of the fact that the differences became not statistically significant at 3 years postoperatively(P<0.05). [Conclusion] Both double-Tsuge loop suture and Achillon techniques are minimally invasive surgery for acute Achilles tendon rupture with advantages of small incision,quick healing, and fewer complications. Compared with Achilon method, the double-Tsuge loop suture achieves considerably improved early outcomes.
[Objective] To compare the clinical outcomes of double-Tsuge loop suture versus Achillon for mini-incision repair of acute Achilles tendon rupture. [Methods] A total of 140 persons were enrolled into this study. Of them, 101 patients had the Achilles tendon repaired by the double-Tsuge loop technique, while the remaining 39 patients had the tendon repaired by Achillon technique. The operation time, hospital stay and complications were recorded for comparison between the two groups.In addition, the Achilles tendon Total Rupture Score(ATRS) and AOFAS ankle-hind foot score were used for evaluation of the clinical consequences. [Results] The patients in the Tsuge group consumed significantly less operation time, associated with significantly shorter hospital stay than those in the Achillon group(P<0.05). The total complication rate proved of 1% in the Tsuge group, whereas 10% in the Achillon group, including only 1 re-rupture of the tendon in the Tsuge group, whereas 1 sural nerve injury, 1 incision infection, 1 shin adhesion and 1 patient died of pulmonary embolism 2 weeks after operation in the Achillon group. Among the patients, 138 were followed up from 6 months to 3 years. Both the ATRS and AOFAS scores significantly increased in the two groups as time went on postoperatively(P<0.05). The Tsuge group proved significantly superior to the Achillon group regarding to ATRS and AOFAS scores at 6 months and 1 year postoperatively(P<0.05), despite of the fact that the differences became not statistically significant at 3 years postoperatively(P<0.05). [Conclusion] Both double-Tsuge loop suture and Achillon techniques are minimally invasive surgery for acute Achilles tendon rupture with advantages of small incision,quick healing, and fewer complications. Compared with Achilon method, the double-Tsuge loop suture achieves considerably improved early outcomes.
引文
[1] M?ller A,?str?m M, Westlin NE. Increasing incidence of Achilles tendon rupture[J]. Acta Orthopaedica Scandinavica, 1996, 67(5):479.
[2]柴明祥,何泽阳,吴希瑞.经皮与开放缝合治疗急性闭合性跟腱断裂的临床研究[J].中国矫形外科杂志, 2016, 24(8):711-716.
[3] Fu C, Qu W. Acute Achilles tendon rupture:Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture[J]. Surg J Royal Colleges Surg Edinburgh Ireland,2015, 13(4):207.
[4] Carmont MR, Heaver C, Pradhan A, et al. Surgical repair of the ruptured Achilles tendon:the cost-effectiveness of open versus percutaneous repair[J]. Knee Surg Sports Traumatol Arthrosc,2013, 21(6):1356-1360.
[5] Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon:a comparative study[J]. Am J Sports Med, 2005, 33(9):1369-1379.
[6] Bruggeman NB, Turner NS, Dahm DL, et al. Wound complications after open Achilles tendon repair:an analysis of risk factors[J].Clin Orthop, 427(427):63.
[7] Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair[J]. Foot Ankle Int, 2004, 25(4):215.
[8] Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon--a prospective randomized controlled study[J]. Foot Ankle Int, 2001, 22(7):559.
[9] Ma GW, Griffith TG. Percutaneous repair of acute closed ruputured achiliies tendon:a new technique[J]. Clin Orthop,1977, 128(128):247-255.
[10] Klein W, Lang D M, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis[J].La Chirurgia Degli Organi Di Movimento, 1991, 76(3):223.
[11] Assal M, Jung M, Stern R, et al. Limited open repair of Achilles tendon ruptures:a technique with a new instrument and findings of a prospective multicenter study[J]. J Bone Joint Surg Am,2002, 84-A(2):161.
[12] Bartel A F, Elliott A D, Roukis T S. Incidence of complications after Achillon?mini-open suture system for repair of acute midsubstance achilles tendon ruptures:a systematic review[J]. J Foot Ankle Surg, 1900, 53(6):744-746.
[13] Haddad Jr RJ, Kester MA, McCluskey GM, et al. Comparative mechanical analysis of a looped-suture tendon repair[J]. J Hand Surg Am, 1988, 13(5):709-713.
[14] Tang JB, Shi D, Gu YQ, et al. Double and multiple looped suture tendon repair[J]. J Hand Surg Br, 1994, 19(6):699-703.
[2]柴明祥,何泽阳,吴希瑞.经皮与开放缝合治疗急性闭合性跟腱断裂的临床研究[J].中国矫形外科杂志, 2016, 24(8):711-716.
[3] Fu C, Qu W. Acute Achilles tendon rupture:Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture[J]. Surg J Royal Colleges Surg Edinburgh Ireland,2015, 13(4):207.
[4] Carmont MR, Heaver C, Pradhan A, et al. Surgical repair of the ruptured Achilles tendon:the cost-effectiveness of open versus percutaneous repair[J]. Knee Surg Sports Traumatol Arthrosc,2013, 21(6):1356-1360.
[5] Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon:a comparative study[J]. Am J Sports Med, 2005, 33(9):1369-1379.
[6] Bruggeman NB, Turner NS, Dahm DL, et al. Wound complications after open Achilles tendon repair:an analysis of risk factors[J].Clin Orthop, 427(427):63.
[7] Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair[J]. Foot Ankle Int, 2004, 25(4):215.
[8] Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon--a prospective randomized controlled study[J]. Foot Ankle Int, 2001, 22(7):559.
[9] Ma GW, Griffith TG. Percutaneous repair of acute closed ruputured achiliies tendon:a new technique[J]. Clin Orthop,1977, 128(128):247-255.
[10] Klein W, Lang D M, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis[J].La Chirurgia Degli Organi Di Movimento, 1991, 76(3):223.
[11] Assal M, Jung M, Stern R, et al. Limited open repair of Achilles tendon ruptures:a technique with a new instrument and findings of a prospective multicenter study[J]. J Bone Joint Surg Am,2002, 84-A(2):161.
[12] Bartel A F, Elliott A D, Roukis T S. Incidence of complications after Achillon?mini-open suture system for repair of acute midsubstance achilles tendon ruptures:a systematic review[J]. J Foot Ankle Surg, 1900, 53(6):744-746.
[13] Haddad Jr RJ, Kester MA, McCluskey GM, et al. Comparative mechanical analysis of a looped-suture tendon repair[J]. J Hand Surg Am, 1988, 13(5):709-713.
[14] Tang JB, Shi D, Gu YQ, et al. Double and multiple looped suture tendon repair[J]. J Hand Surg Br, 1994, 19(6):699-703.