摘要
目的探究应用超声定位下小切口辅助改良经皮缝合法治疗急性闭合性跟腱断裂的临床疗效。方法回顾性分析2020年4月—2023年8月联勤保障部队第九〇八医院骨科收治的采用超声定位下小切口辅助改良经皮缝合法治疗急性闭合性跟腱断裂患者22例,其中篮球运动损伤17例,足球运动损伤3例,400米障碍损伤2例。患者中男性18例,女性4例;年龄20~55岁,平均34.5岁。受伤至手术时间0.3~2.3 d,平均1.5 d。术前利用麻醉科便携式超声标记腓肠神经,术中先在断端处皮肤取2.5~3.0 cm小切口,理顺固定两侧断端跟腱,用2-0非吸收外科缝线编织缝合法交叉贯穿缝合跟腱。术后跟腱活动情况采用美国足踝外科协会(AOFAS)踝-后足评分、跟腱完全断裂评分(ATRS)进行评价,康复效果情况采用Arner-Lindholm评定标准进行评价。结果术后随访9~24个月,平均14.7个月。末次随访时AOFAS踝-后足评分:优16例,平均(95.6±2.8)分;良6例,平均(84.8±5.1)分,总平均(92.6±6.0)分。ATRS评分平均(91.9±7.3)分。Arner-Lindholm评价优16例,良6例。总体评价指标均达到优良。患者切口均愈合良好,无皮缘坏死和跟腱粘连,无切口感染和腓肠神经损伤,至随访结束未发生跟腱再次断裂,均恢复伤前生活状态及运动水平。MRI检查结果均显示跟腱连续性良好。结论超声定位下小切口辅助改良经皮缝合法既能减少伤口感染、坏死等并发症,又能降低神经损伤风险,无需借助特殊器械,具有操作简便、创伤小、并发症少、恢复好等优势。
Objective To explore the clinical efficacy of ultrasound-guided small incision-assisted modified percutaneous suture in the treatment of acute closed Achilles tendon rupture.Methods This retrospective analysis was conducted on 22 patients with acute closed Achilles tendon rupture who were treated by ultrasound-guided small incision-assisted modified percutaneous suture in the Department of Orthopedics,No.908 Hospital of PLA Joint Logistics Support Force from Apr.2020 to Aug.2023,including 17 cases due to basketball sports,3 due to football sports,and 2 due to 400-m obstacle running.Among the patients,there were 18 males and 4 females aged 20-55(mean 34.5)years,with the median time from injury to surgery being 0.3-2.3 d(mean 1.5).Preoperatively,a portable anesthesia ultrasound machine was used to label the sural nerve.Intraoperatively,a small incision of 2.5-3.0 cm was made on the skin at the severed end.Then the Achilles tendons on both sides were straightened and fixed,which were latersutured using a 2-0 nonabsorbable suture by the weaving method.Postoperatively,the function of the Achilles tendon activity was evaluated using the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and Achilles complete rupture score(ATrS),and the rehabilitation effect was evaluated using the Arner-Lindholm criteria.Results Patients were followed up for9-24(mean 14.7)months.At last follow-up,the AOFAS-ankle-hindfoot score was excellent in 16 cases,with an average score of 95.6±2.8,and good in the rest 6 cases,with an average score of 84.8±5.1.The total AOFAS ankle-hindfoot score was 92.6±6.0,and the ATrS was 91.9±7.3.The Arner-Lindholm criteria defined 16 cases as excellent and the rest 6 as good.No poorResults were reported.All patients had good wound healing,without any skin edge necrosis,Achilles tendon adhesion,incision infection orsural nerve injuries.Until the end of follow-up,there was no recurrence of rupture,and patients obtained theirpre-injury living and physical activity levels.The MrI exam also sho
作者
彭祥
李浩
韩露
梁桂金
刘继春
杨迪
万得恩
刘丽玲
闫红莲
何菲
双峰
Peng Xiang;Li Hao;Han Lu;Liang Guijin;Liu Jichun;Yang Di;Wan Deen;Liu Liling;Yan Honglian;He Fei;Shuang Feng(Department of Orthopedics,No.908 Hospital of PLA Joint Logistic Support Force,Nanchang 330002,China;Department of Anesthesiology,No.908 Hospital of PLA Joint Logistic Support Force,Nanchang 330002,China;Department of Quality Management,No.908 Hospital of PLA Joint Logistic Support Force,Nanchang 330002,China)
出处
《创伤外科杂志》
2024年第12期905-910,共6页
Journal of Traumatic Surgery
基金
江西省卫健委课题(202211373,202211380)
第九〇八医院苗子基金课题(2022YNKT003,2022YNKT030)。
关键词
跟腱断裂
超声定位
小切口
改良经皮缝合法
Achilles tendon rupture
Ultrasound localization
Small incision
Modified percutaneous suture
