摘要
目的比较束束缝合与Krackow缝合治疗急性闭合性跟腱断裂的临床疗效。方法采用回顾性队列研究分析2014年8月至2021年8月同济大学附属同济医院收治的58例急性闭合性跟腱断裂患者的临床资料,其中男53例,女5例;年龄27~55岁[(39.6±7.1)岁]。患者均采用切开修复方式治疗,将其分为束束缝合组(30例)和Krackow缝合组(28例)。比较两组切口长度、手术时间。观察跟腱愈合情况。术后12个月测量患侧和健侧小腿周径差值、跟腱断端横断面宽径与前后径比值及跟腱断端横断面瘢痕组织占腱性纤维组织的比例,并进行跟腱完全断裂评分(ATRS)和美国足踝外科协会(AOFAS)踝-后足评分。随访期间,观察并发症发生情况。结果患者均获随访12~28个月[(17.9±4.2)个月]。束束缝合组切口长度、手术时间分别为6.0(4.5,9.0)cm、77.5(60.0,95.0)min,明显短于或长于Krackow缝合组的8.0(7.0,11.0)cm、68.5(55.0,86.0)min(P均<0.01)。两组术后3个月跟腱均获愈合。术后12个月束束缝合组患侧与健侧小腿周径差值为(2.0±0.9)cm,Krackow缝合组为(1.9±0.9)cm(P>0.05);束束缝合组跟腱断端横断面宽径与前后径比值为1.42±0.20,明显大于Krackow缝合组的1.27±0.16(P<0.01);束束缝合组跟腱断端横断面瘢痕组织占腱性纤维组织的比例为8.6%(6.0%,24.0%),明显小于Krackow缝合组的11.9%(9.0%,33.0%)(P<0.01)。束束缝合组ATRS和AOFAS踝-后足评分分别为91.5(80.0,99.0)分和93.0(82.0,100)分,Krackow缝合组分别为89.0(75.0,99.0)分和91.5(77.0,99.0)分(P均>0.05)。随访期间,束束缝合组无深部感染,早期跟腱再断裂2例(7%);Krackow缝合组深部感染1例(4%),早期跟腱再断裂1例(4%)(P均>0.05)。结论束束缝合与Krackow缝合治疗急性闭合性跟腱断裂均可获得满意的临床疗效。但束束缝合更有利于恢复跟腱正常解剖形态并减少跟腱断端瘢痕形成。
Objective To compare the clinical efficacy of bundle suture and Krackow suture in the treatment of acute closed Achilles tendon rupture.Methods A retrospective cohort study was used to analyze the clinical data of 58 patients with acute closed Achilles tendon rupture admitted to Tongji Hospital of Tongji University from August 2014 to August 2021,including 53 males and 5 females,aged 27-55 years[(39.6±7.1)years].The patients were treated with open repair and were assigned to bundle suture group(n=30)and Krackow suture group(n=28).The incision length and operative time were compared between the two groups.The healing of the Achilles tendon was observed.The difference in circumference between the affected and healthy side of the calf,ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture,and ratio of scar tissue to tendinous fibrous tissue at the cross-sectional area of Achilles tendon rupture were measured at 12 months after surgery.At the same time,the complete Achilles tendon rupture score(ATRS)and American Foot and Ankle Surgery Society(AOFAS)ankle-hindfoot score were performed.The occurrence of complications was observed at follow-up.Results All patients were followed up for 12-28 months[(17.9±4.2)months].The incision length and operative time in bundle suture group[6.0(4.5,9.0)cm,77.5(60.0,95.0)minutes]were significantly shorter or longer than those in Krackow suture group[8.0(7.0,11.0)cm,68.5(55.0,86.0)minutes](all P<0.01).After 3 months,healing of the Achilles tendon was obtained in both groups.After 12 months,the difference in circumference between the affected and healthy side of the calf was(2.0±0.9)cm in bundle suture group and was(1.9±0.9)cm in Krackow suture group(P>0.05);the ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture was 1.42±0.20 in bundle suture group,significantly greater than 1.27±0.16 in Krackow suture group(P<0.01);the ratio of scar tissue to tendinous fibrous tissue at the cross-sectio
作者
夏江
徐少晨
黄辉
李兵
于涛
赵有光
朱辉
杨云峰
Xia Jiang;XuShaochen;Huang Hui;Li Bing;Yu Tao;Zhao Youguang;ZhuHui;Yang Yunfeng(Department of Orthopedics,Tongji Hospital of Tongji University,Shanghai 200065,China;Department of Orthopedics,Shanghai Baoshan District Wusong Central Hospital,Shanghai 200940,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第6期504-509,共6页
Chinese Journal of Trauma
基金
上海市科技计划项目(21ZR1458500)
上海市同济医院临床培育项目(ITJ(ZD)2004)。
关键词
跟腱
腱损伤
缝合技术
治疗结果
Achilles tendon
Tendon injuries
Suture techniques
Treatment outcome
