改良Ma-Griffith经皮缝合在急性跟腱断裂治疗中的应用
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摘要
目的探讨应用改良Ma-Griffith经皮缝合法在外伤后闭合新鲜跟腱断裂中的应用及并发症,同时评估该方法的可行性及有效性,归纳其并发症,分析并发症发生的原因及处理对策。方法收集第四军医大学唐都医院骨三科2012-2016年采用改良Ma-Griffith经皮缝合法治疗外伤后新鲜跟腱断裂的29例患者的临床资料,根据术前、术后查体及术前术后X线、B超及MRI影像检查,记录观测术后有无腓肠神经支配区感觉减退、有无跟腱再断裂、有无伤口感染等情况,同时采用跟腱完全断裂评分标准ATRSA及AOFAS评分标准进行评分双重判定,定期随访单足体踵力量及踝关节活动度情况。结果采用改良Ma-Griffith经皮缝合法治疗新鲜跟腱断裂AOFAS评分优良率达89.7%,术后患者未出现足背外侧麻木等腓肠神经损伤,1例伤口延迟愈合,1例出现深静脉血栓并发肺栓塞,ATRSA平均评分89.1分。结论通过分析新鲜的不同类型的跟腱断裂,选择不同的经皮缝合方法,既有软组织损伤小、防止术后再粘连的优点,同时又能达到充分的固定强度,减少跟腱再断裂的可能,在临床中可作为一种治疗方法给予推广使用。
Objective To investigate the curative effect and complications of acute closed achilles tendon rupture with the appliction of modified Ma-Griffith suture.To evaluate the feasibility and effectiveness of the method,and to summarized the complications, causes and treatment countermeasures of complications. Methods Used the modified Ma-Griffith percutaneous suture treat 29 cases acute achilles tendon rupture from 2012 to 2016.Applying the preoperative and postoperative examination,preoperative and postoperative X-ray,ultrasound and MRI imaging examination.Postoperative observation records of nerve hypoesthesia,achilles tendon again,wound infection.Judgment was carried out by using ATRSA and AOFAS.Finally,the strength and ankle joint motion was regular follow-up. Results When the modified Ma-Griffith percutaneous suture was used for the treatment of fresh achilles tendon rupture,AOFAS score excellent rate was 89.7%,no patients experienced numbness of lateral dorsal sural nerve injury after operation,1 cases of delayed wound healing,1 cases of deep vein thrombosis and pulmonary embolism,the average ATRSA score was 89.1. Conclusion Through the analysis of different types of fresh achilles tendon rupture, the choice of different percutaneous suture method not only has the advantages of small soft tissue injury, prevent postoperative adhesion,but also achieve adequate fixation strength,reduce achilles tendon rupture. modified Ma-Griffith percutaneous suture have the value for clinical application.
Objective To investigate the curative effect and complications of acute closed achilles tendon rupture with the appliction of modified Ma-Griffith suture.To evaluate the feasibility and effectiveness of the method,and to summarized the complications, causes and treatment countermeasures of complications. Methods Used the modified Ma-Griffith percutaneous suture treat 29 cases acute achilles tendon rupture from 2012 to 2016.Applying the preoperative and postoperative examination,preoperative and postoperative X-ray,ultrasound and MRI imaging examination.Postoperative observation records of nerve hypoesthesia,achilles tendon again,wound infection.Judgment was carried out by using ATRSA and AOFAS.Finally,the strength and ankle joint motion was regular follow-up. Results When the modified Ma-Griffith percutaneous suture was used for the treatment of fresh achilles tendon rupture,AOFAS score excellent rate was 89.7%,no patients experienced numbness of lateral dorsal sural nerve injury after operation,1 cases of delayed wound healing,1 cases of deep vein thrombosis and pulmonary embolism,the average ATRSA score was 89.1. Conclusion Through the analysis of different types of fresh achilles tendon rupture, the choice of different percutaneous suture method not only has the advantages of small soft tissue injury, prevent postoperative adhesion,but also achieve adequate fixation strength,reduce achilles tendon rupture. modified Ma-Griffith percutaneous suture have the value for clinical application.
引文
[1]Longo U G,Petrillo S,Maffulli N,et al.Acute achilles tendon rupture in athletes[J].Foot Ankle Clin,2013,(18):319-338.
[2]Jones MP,Khan RJ,Carey Smith R L.Surgical interventions for treating acute achilles tendon rupture:key findings from a recent cochrane review[J].J Bone Joint Surg Am,2012,94(12):88.
[3]Hsu AR,Jones CP,Cohen BE,et al.Clinical outcomes and complications of percutaneous achilles repair system versus open technique for acute achilles tendon ruptures[J].Foot Ankle Int,2015,36(11):1279-1286.
[4]Lim J,Dalal R,Waseem M.Percutaneous vs open repair of the ruptured Achilles tendon-a prospective randomized controlled study[J].Foot Ankle Int,2001,22:559-568.
[5]Willits K,Amendola A,Bryant D,et al.Operative versus nonoperative treatment of acute Achilles tendon ruptures:a multicenter randomized trial using accelerated functional rehabilitation[J].J Bone Joint Surg Am,2010,(92):2767-2775.
[6]陈柯屹,张梦苑,杨广忠,等.微创与传统切开治疗急性闭合性跟腱断裂疗效的Meta分析[J].中国矫形外科杂志,2013,21(24):2449-2454.
[7]张江,彭建强,白波,等.不同缝合方法与缝线修复跟腱断裂的生物力学研究[J].中国骨与关节损伤杂志,2013,28(2):131-133.
[8]Wallace RG,Heyes GJ,Michael AL.The non operative functional management of patients with a rupture of the tendon achilles leads to low rates of re-rupture[J].The Journal of Bone and Joint Surgery British Volume,2011,93(10):1362-1366.
[9]Maes R,Copin G,Averous C.Is percutaneous repair of the Achilles tendon a safe technique?A study of 124 cases[J].Acta Orthop Belg,2006,72(2):179-183.
[10]Nilsson-Helander K,Thurin A,Karlsson J,et al.High incidence of deep venous thrombosis after Achilles tendon rupture:a prospective study[J].Knee Surg Sports Traumatol Arthrosc,2009,(17):1234-1238.
[11]Patel A,Ogawa B,Charlton T,et al.Incidence of deep vein thrombosis and pulmonary embolism after Achilles tendon rupture[J].Clin Orthop Relat Res,2012,(470):270-274.
[12]Makhdom A M,Cota A,Saran N,et al.Incidence of symptomatic deep venous thrombosis after Achilles tendon rupture[J].J Foot Ankle Surg,2013(52):584-587.
[13]Lapidus L J,Rosfors S,Ponzer S,et al.Prolonged throm boprophylaxis with dalteparin after surgical treatment of Achilles tendon rupture:a randomized,place bocontrolled study[J].J Orthop Trauma,2007,(21):52-57.
[2]Jones MP,Khan RJ,Carey Smith R L.Surgical interventions for treating acute achilles tendon rupture:key findings from a recent cochrane review[J].J Bone Joint Surg Am,2012,94(12):88.
[3]Hsu AR,Jones CP,Cohen BE,et al.Clinical outcomes and complications of percutaneous achilles repair system versus open technique for acute achilles tendon ruptures[J].Foot Ankle Int,2015,36(11):1279-1286.
[4]Lim J,Dalal R,Waseem M.Percutaneous vs open repair of the ruptured Achilles tendon-a prospective randomized controlled study[J].Foot Ankle Int,2001,22:559-568.
[5]Willits K,Amendola A,Bryant D,et al.Operative versus nonoperative treatment of acute Achilles tendon ruptures:a multicenter randomized trial using accelerated functional rehabilitation[J].J Bone Joint Surg Am,2010,(92):2767-2775.
[6]陈柯屹,张梦苑,杨广忠,等.微创与传统切开治疗急性闭合性跟腱断裂疗效的Meta分析[J].中国矫形外科杂志,2013,21(24):2449-2454.
[7]张江,彭建强,白波,等.不同缝合方法与缝线修复跟腱断裂的生物力学研究[J].中国骨与关节损伤杂志,2013,28(2):131-133.
[8]Wallace RG,Heyes GJ,Michael AL.The non operative functional management of patients with a rupture of the tendon achilles leads to low rates of re-rupture[J].The Journal of Bone and Joint Surgery British Volume,2011,93(10):1362-1366.
[9]Maes R,Copin G,Averous C.Is percutaneous repair of the Achilles tendon a safe technique?A study of 124 cases[J].Acta Orthop Belg,2006,72(2):179-183.
[10]Nilsson-Helander K,Thurin A,Karlsson J,et al.High incidence of deep venous thrombosis after Achilles tendon rupture:a prospective study[J].Knee Surg Sports Traumatol Arthrosc,2009,(17):1234-1238.
[11]Patel A,Ogawa B,Charlton T,et al.Incidence of deep vein thrombosis and pulmonary embolism after Achilles tendon rupture[J].Clin Orthop Relat Res,2012,(470):270-274.
[12]Makhdom A M,Cota A,Saran N,et al.Incidence of symptomatic deep venous thrombosis after Achilles tendon rupture[J].J Foot Ankle Surg,2013(52):584-587.
[13]Lapidus L J,Rosfors S,Ponzer S,et al.Prolonged throm boprophylaxis with dalteparin after surgical treatment of Achilles tendon rupture:a randomized,place bocontrolled study[J].J Orthop Trauma,2007,(21):52-57.