急性跟腱断裂修复术后短腿石膏托固定的可行性研究

目的利用活体动物模型探索急性跟腱断裂修复术后应用短腿石膏进行固定的可行性。方法通过力学实验检测踝关节极度跖屈不同屈膝角度时跟腱处的拉力。建立急性跟腱断裂修复模型,分别应用长、短石膏进行固定3周,检测并比较分析术前、术后腓肠肌和股二头肌的拉力变化,通过组织学观察两种固定方式的跟腱组织愈合情况。结果当踝关节极度跖屈时,腓肠肌收缩在跟腱处产生的拉力与屈膝角度无关。长、短石膏固定后都会出现腓肠肌肌力减低,但长腿石膏固定组更加显著;同时长腿石膏固定组还会导致股二头肌肌力显著性减低,而短腿石膏固定组则不会。两组跟腱组织愈合情况相近,无显著性差异。结论在急性跟腱断裂修复术后应用短腿石膏固定是可行的,不会影响跟腱组织的愈合。     

跟腱断裂术后伤口愈合困难的原因及防治

跟腱断裂是创伤外科中的常见疾病，常需急诊修复跟腱，术后石膏固定6～8周，术后伤口难愈合，给临床工作和患者及家属带来不少的麻烦，也会造成不必要的医疗纠纷，1999年5月至2006年10月间，我院治疗15例跟腱断裂患者，其中5例并发伤口难愈合，为总结经验，现作回顾分析。     

跟腱断裂手术并发症原因分析

本组35例,均为男性患者。年龄23～48岁。新鲜跟腱断裂29例,陈旧性6例。手术方法:跟腱内侧纵形切口,断端直接缝合或翻瓣加强缝合,踝关节蹠屈位长腿石膏外固定4～6周。术后发生皮肤切口窦道、跟腱外露者6例;跟腱再次断裂3例,其中2例切口为Ⅰ期愈合,于术后5、6周发生再断裂;皮肤与跟腱粘连者4例。     

跟腱断裂改良Kessler缝合手术的疗效分析

目的分析跟腱断裂行改良Kessler缝合的手术疗效。方法对20例闭合性跟腱断裂患者行改良Kessler缝合手术治疗,观察疗效,分析并发症的原因。结果随访1.5年,采用Arner-Lindholm评定标准评估:优11例,良8例,差1例。1例伤口延迟愈合,二期手术愈合;1例术后8周发生跟腱再次断裂,二次手术后功能良好。结论跟腱断裂行改良Kessler缝合手术是有效的治疗方法。仔细操作,采取积极措施,避免并发症,可以提高手术疗效。     

应用同种异体肌腱加强修复治疗陈旧性跟腱断裂

目的探讨同种异体肌腱加强修复治疗陈旧性跟腱断裂的临床疗效。方法2005年1月至2011年12月,对26例陈旧性跟腱断裂患者,采用同种异体肌腱在跟腱断裂两侧的正常跟腱组织冠状面钻孔环扎,加强修复断裂的跟腱。结果26例均获随访9～52个月,平均30．7个月,除1例术后伤口延迟愈合外,其余伤口均I期愈合,无全身或局部不良反应,无跟腱黏连再手术者,无跟腱再断裂发生。采用Arner—Lindholm疗效评定方法,优22例（84．6％）,良4例（15．4％）。结论同种异体肌腱加强修复治疗陈旧性跟腱断裂疗效满意,并发症少,手术操作简单,是一种可行的手术方法。     

两种方法治疗新鲜闭合跟腱断裂

目的 比较跟腱断裂通道微创修复和传统开放切口直视下修复治疗新鲜闭合跟腱断裂的疗效.方法 将43例新鲜闭合跟腱断裂患者根据治疗方法 不同分为微创组(采用跟腱断裂通道微创修复术治疗,25例)和传统组(采用传统开放切口直视下修复术治疗,18例).比较两组切口长度、手术时间、切口愈合时间、术后并发症、疼痛评分及踝关节功能评分....     

跟腱断裂术后并发症的预防及原因分析

目的对跟腱断裂术后并发症的原因、治疗及预防措施进行分析总结,指导临床,以期做到从术前即开始预防跟腱断裂术后并发症。方法我院2006年2月至2009年12月手术治疗跟腱断裂患者82例,其中男56例,女13例,年龄25～63岁,均采用跟腱内侧纵行切口,kessler方法缝合。结果本组69例获得随访,随访时间11～37个月,平均25.6个月。按A rnerL indho lm评分标准评定,优56例,良11例,差2例,优良率为97.1%。术后切口愈合不良5例,切口感染2例,跟腱再断裂2例。结论跟腱断裂手术疗效取决于准确的早期诊断、正确而且微创的手术操作和规范的康复训练。     

硬膜穿刺针建立通道小切口缝合手术治疗急性跟腱断裂

目的探讨硬膜穿刺针建立通道小切口缝合手术治疗急性跟腱断裂的临床疗效。方法纳入自2015-08—2017-10诊治的28例急性跟腱断裂,急诊使用硬膜穿刺针建立通道,作小切口采用改良Bunnell缝合法缝合断裂跟腱。术后第3个月行MRI检查跟腱愈合情况,同时检查踝关节背伸及跖曲活动度。术后第6个月时采用美国Biodex System-3型等速肌力测试仪测定30°/s时患侧跖曲峰力矩评价患足跖曲力量。结果 28例均获得随访,随访时间平均9.8(9～12)个月。切口均愈合良好,未出现切口感染、腓肠神经损伤、患侧跟腱再断裂情况。术后3个月时复查MRI显示跟腱均愈合良好,踝关节背伸活动度平均18.5°(8°～30°),跖曲活动度平均41.6°(35°～50°)。术后6个月时30°/S条件下患侧踝关节跖曲峰力矩平均145.6 (73～200)N·m。结论急诊使用硬膜穿刺针建立通道小切口缝合手术治疗急性跟腱断裂的临床疗效确切,具有操作简单、创伤小、并发症少、术后恢复快等优点,适合在基层医院开展。     

后内侧入路结合皮内缝合治疗跟腱断裂

目的探讨后内侧入路结合可吸收线皮内缝合治疗跟腱断裂的疗效.方法：采取后正中旁内侧入路结合可吸收线皮内缝连续合治疗闭合跟腱断裂43例,观察术后皮缘坏死率、感染率及术后6个月切口瘢痕愈合情况.结果：43例术后随访10～22个月,平均15个月;1例术后10周再次拉伤,42例切口愈合好、瘢痕小,根据Arner-Lindholm疗效评定标准,优38例,良4例,差1例,优良率98%.结论：采用后正中旁内侧入路结合可吸收线皮内缝连续合治疗跟腱断裂,切口愈合好、瘢痕小、皮缘坏死及切口感染发生率低.     

异体灭活肌腱加固修复严重撕脱性跟腱断裂损伤

目的探讨异体灭活肌腱用于加固修复严重撕脱性跟腱断裂损伤的临床疗效。方法 2014年1月至2017年3月,我科共收治急性闭合性跟腱断裂患者26例,其中11例术中探查发现跟腱为严重撕脱性损伤,男9例,女2例;年龄27～47岁,平均年龄35.3岁。均采用切开缝合跟腱后异体灭活肌腱加固修复。术后观察切口愈合情况、并发症发生情况,并在术后3、6、12个月采用美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足评分标准评价踝关节功能。结果所有患者切口均I期愈合,没有患者出现异体肌腱排异现象。术后3、6、12个月AOFAS踝-后足评分分别为(90.3±4.7)分、(94.2±3.3)分、(97.2±2.6)分。无患者发生跟腱再断裂和腓肠神经损伤等并发症。结论异体灭活肌腱排异性小,用于加固修复严重撕脱性跟腱断裂疗效满意,可作为治疗严重撕脱性跟腱断裂损伤的一种方案。     

Endoscopic Surgery for Delayed Wound Healing After Achilles Tendon Suture Repair: A Report of Three Cases

BackgroundDelayed wound healing is a potention complication after Achilles tendon suture repair and occurs for various reasons. The conventional treatment for delayed wound healing is open surgery, but patients face long recovery times and postoperative care is difficult.Case PresentationThis report presents three patients who were seen at our institute from April 2008 to October 2017 due to long‐term non‐healing wounds after surgery. All three patients had undergone surgery at least 2 months previously. We performed endoscopic surgery on these patients. After the operation, patients received less antibiotics and simpler care than would be required for conventional open surgery. There is no need to keep the wound open after the operation or perform wound cleaning for multiple times at the same time, which can reduce healing time. At the last follow up, all postoperative scores among the patients were significantly improved compared to before surgery. The Achilles tendon total rupture scores were excellent and the American Orthopedic Foot and Ankle Society scores were satisfactory, indicating improvements in Achilles tendon function and movement in patients after surgery.ConclusionOur case reports demonstrate that arthroscopic treatment for delayed wound healing after Achilles tendon suture repair is satisfactory and reliable; frequent opening of the wound for cleaning is not required after the operation, thus reducing the healing time.     

Value of magnetic resonance imaging in monitoring Achilles tendon healing after percutaneous suture using the Dresden technique

PurposeTendon healing is a complex process taking place in several stages. There is a paucity of data on tendon morphology after percutaneous repair for acute Achilles tendon rupture.Materials and methodsWe used high field MRI (1.5 Tesla to 3 Tesla) with T1 and T2-weighted sequences including fat suppression to assess the healing process after percutaneous Achilles tendon repair using the Dresden technique. MRI was performed at 3, 6, 8 and 12 months postoperatively.ResultsDuring tendon repair a gradual transition from an irregular and hyperintense signal toward a more homogeneous and hypointense signal was observed inside the Achilles tendon after percutaneous repair. These changes took place centripetally. During the early and late remodeling phase at 6 and 12 months, respectively, the tendons look thickened and homogeneous in both sequences.ConclusionsMRI represents an excellent means of monitoring the healing process after percutaneous Achilles tendon repair. The results of the present study confirm that the percutaneous, peritendineum preserving technique with the Dresden instrument results in a near physiologic centripetal tendon healing.     

A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture

ObjectiveAcute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture.MethodsFifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography.ResultsMean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients.ConclusionsThe novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.     

Effects of Pulsed Electromagnetic Field Therapy on Rat Achilles Tendon Healing

The Achilles tendon is frequently injured. Data to support specific treatment strategies for complete and partial tears is inconclusive. Regardless of treatment, patients risk re-rupture and typically have long-term functional deficits. We previously showed that pulsed electromagnetic field (PEMF) therapy improved tendon-to-bone healing in a rat rotator cuff model. This study investigated the effects of PEMF on rat ankle function and Achilles tendon properties after (i) complete Achilles tendon tear and repair with immobilization, (ii) partial Achilles tendon tear without repair and with immobilization, and (iii) partial Achilles tendon tear without repair and without immobilization. We hypothesized that PEMF would improve tendon properties, increase collagen organization, and improve joint function, regardless of injury type. After surgical injury, animals were assigned to a treatment group: (i) no treatment control, (ii) 1 h of PEMF per day, or (iii) 3 h of PEMF per day. Animals were euthanized at 1, 3, and 6 weeks post-injury. Joint mechanics and gait analysis were assessed over time, and fatigue testing and histology were performed at each time point. Results indicate no clear differences in Achilles healing with PEMF treatment. Some decreases in tendon mechanical properties and ankle function suggest PEMF may be detrimental after complete tear. Some early improvements were seen with PEMF after partial tear with immobilization; however, immobilization was found to be a confounding factor. This body of work emphasizes the distinct effects of PEMF on tendon-to-bone healing and supports trialing potential treatment strategies pre-clinically across tendons before applying them clinically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:70–81, 2020     

Structural and biomechanical characteristics after early mobilization in an achilles tendon rupture model: operative versus nonoperative treatment

Acute Achilles tendon ruptures are common sports injuries; however, treatment remains a clinical challenge. Studies show a superior effect of early mobilization and full weight bearing on tendon healing and clinical outcome; however, few data exist on structural and biomechanical characteristics in the early healing phase. This study investigated the histological and biomechanical characteristics of early mobilization and full weight bearing in an Achilles tendon rupture model. Eighty rats underwent dissection of a hindpaw Achilles tendon; 40 rats were treated conservatively and 40 underwent open repair of the transected Achilles tendon by suturing. Early mobilization and full weight bearing were allowed in both groups. At 1, 2, 4, and 8 weeks after tenotomy, tensile strength, stiffness, thickness, tissue characteristics (histological analysis), and length were determined. Dissected Achilles tendons healed in all animals during full weight-bearing early mobilization. One and 2 weeks after tenotomy, rats in the operative group showed increased tensile strength and stiffness compared with the nonoperative group. Repair-site diameters were increased at 1, 2, and 8 weeks after tenotomy. Tendon length was decreased in the operative group throughout observation, whereas the nonoperative group showed increased structural characteristics on the cellular level and a more homogeneous collagen distribution. Surgical treatment of dissected rat Achilles tendons showed superior biomechanical characteristics within the first 2 weeks. Conservative treatment resulted in superior histological findings but significant lengthening of the tendon in the early healing phase (weeks 1-8).     

三种手术方法治疗新鲜跟腱断裂比较研究

目的比较传统切开跟腱吻合术、经皮微创跟腱吻合术以及应用跟腱吻合器有限切开术治疗新鲜闭合性跟腱断裂的疗效,为临床治疗方式的选择提供参考依据。方法 2007年12月-2010年3月将69例符合纳入标准的新鲜闭合性跟腱断裂患者随机分为3组,其中采用传统切开跟腱吻合术23例(传统切开组),经皮微创跟腱吻合术23例(经皮微创组),应用跟腱吻合器有限切开治疗23例(有限切开组)。3组患者性别、年龄、损伤机制、美国足踝外科协会(AOFAS)踝-后足评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果经皮微创组及有限切开组住院时间及失血量明显优于传统切开组(P<0.01)。术后传统切开组发生2例(8.7%)切口感染坏死,其余两组患者切口均Ⅰ期愈合;传统切开组术后腱旁组织并发症发生率高于其余两组(P<0.05)。经皮微创组及有限切开组各1例(4.3%)发生跟腱再断裂,传统切开组跟腱再断裂发生率(0)低于其余两组(P<0.05)。69例均获随访,随访时间12～18个月,平均14.9个月。术后12个月3组踝关节AOFAS评分均>90分,较同组术前显著改善(P<0.05),组间比较差异无统计学意义(P>0.05)。结论 3种手术方式均能有效治疗新鲜跟腱断裂,有限切开或经皮微创手术方法创伤小,伤口愈合好,住院时间少,术后腱旁组织并发症少,但跟腱再断裂风险增加。     

Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture

IntroductionDeep infection after reconstruction of chronic Achilles tendon rupture is a major and intractable complication.Case reportWe report a case of late deep infection following a surgery for chronic Achilles tendon rupture, and its simple and successful treatment with negative pressure wound therapy (NPWT). Six months following the reconstruction of chronic Achilles tendon rupture, a deep infection developed and reconstructed part of the tendon ruptured again. After appropriate debridement.DiscussionThere is no definitive treatment strategy for postoperative infection following open Achilles tendon repair. NPWT was applied to the wound, to promote wound healing and healthy granulation. In our case, NPWT promoted the wound healing and the infected Achilles tendon with tendon loss formed a healthy bridge with granulation tissue spontaneously. The patient resumed her normal activities of daily living, without requiring tendon transfer surgery. NPWT seems to be a simple and successful candidate for this situation.ConclusionNPWT seems to be effective for the treatment of postoperative infection following Achilles tendon repair, even in cases of tendon loss.     

Histological and biomechanical analysis of the effects of streptozotocin-induced type one diabetes mellitus on healing of tenotomised Achilles tendons in rats

BackgroundTendon healing is impaired in patient with diabetes mellitus. The effects of streptozotocin-induced type 1 diabetes (STZ-D) on the healing of the transected Achilles tendon in rats was studied.MethodsIn the experimental group, type one diabetes was induced via administration of STZ. The right Achilles tendon of all the rats was transected 30 days after the STZ administration. The Achilles tendons were examined for biomechanical and histological examinations.ResultsThe statistical analysis showed that Young's modulus of elasticity and stress tensile load of the control group were significantly higher than those of the experimental group, and inflammation in the experimental group was significantly higher than that in the control group. At the same time, fibrosis in the experimental group was significantly lower than that of the control group.ConclusionInduction of type 1 diabetes by STZ significantly delayed the healing of the transected Achilles tendon in rats.     

Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial

BACKGROUND: Limited ankle dorsiflexion has been implicated as a contributing factor to plantar ulceration of the forefoot in diabetes mellitus. The purpose of this study was to compare outcomes for patients with diabetes mellitus and a neuropathic plantar ulcer treated with a total-contact cast with and without an Achilles tendon lengthening. Our primary hypothesis was that the Achilles tendon lengthening would lead to a lower rate of ulcer recurrence. Methods: Sixty-four subjects were randomized into two treatment groups, immobilization in a total-contact cast alone or combined with percutaneous Achilles tendon lengthening, with measurements made before and after treatment, at the seven-month follow-up examination, and at the final follow-up evaluation (a mean [and standard deviation] of 2.1 +/- 0.7 years after initial healing). There were thirty-three subjects in the total-contact cast group and thirty-one subjects in the Achilles tendon lengthening group. There were no significant differences in age, body-mass index, or duration of diabetes between the groups. Outcome measures were time to healing of the ulcer, ulcer recurrence rate, range of dorsiflexion of the ankle, peak torque (strength) of the plantar flexor muscles, and peak plantar pressures on the forefoot. RESULTS: Twenty-nine (88%) of thirty-three ulcers in the total-contact cast group and all thirty ulcers (100%) in the Achilles tendon lengthening group healed after a mean duration (and standard deviation) of 41 +/- 28 days and 58 +/- 47 days, respectively (p > 0.05). (One patient in the Achilles tendon lengthening group died before treatment was completed.) In the first seven months of follow-up, sixteen (59%) of the twenty-seven patients in the total-contact cast group who were available for follow-up and four (15%) of the twenty-seven patients in the Achilles tendon lengthening group who were available for follow-up had an ulcer recurrence (p = 0.001). At the time of the two-year follow-up, twenty-one (81%) of the twenty-six patients in the total-contact cast group and ten (38%) of the twenty-six patients in the Achilles tendon lengthening group had ulcer recurrence (p = 0.002). Compared with the group treated with the total-contact cast, the group treated with Achilles tendon lengthening had increased dorsiflexion and it remained increased at seven months (p < 0.001). Plantar flexor peak torque also decreased after Achilles tendon lengthening (p < 0.004), but it returned to baseline after seven months. Peak plantar pressures on the forefoot during barefoot walking were reduced (p < 0.0002) following Achilles tendon lengthening yet returned to baseline values within seven months after treatment. CONCLUSIONS: All ulcers healed in the Achilles tendon lengthening group, and the risk for ulcer recurrence was 75% less at seven months and 52% less at two years than that in the total-contact cast group. Achilles tendon lengthening should be considered an effective strategy to reduce recurrence of neuropathic ulceration of the plantar aspect of the forefoot in patients with diabetes mellitus and limited ankle dorsiflexion (相似文献