导针引导微创缝合治疗急性闭合性跟腱断裂

目的探讨应用硬膜外穿刺导针引导,微创小切口缝合急性闭合性跟腱断裂的手术疗效。方法急性跟腱断裂病人29例,根据治疗方式不同分为导针引导微创小切口缝合组16例,传统开放缝合组13例。病人于伤后5小时~5天内行跟腱手术修补,术后行个性化长腿及短腿石膏固定,功能锻炼1~2个月;所有病人随访至少1年;比较病人手术时间,术后并发症(切口感染,腓肠神经损伤,跟腱再断裂)和术前、术后1年美国矫形足踝协会评分(AOFAS)及跟腱完全断裂评分(ATRS)。结果传统开放缝合组手术时间为(48.91±12.56)分钟,微创组(41.78±9.56)分钟,两者比较差异无统计学意义(P>0.05);两组均未出现术后腓肠神经损伤及跟腱再断裂情况,传统组在随访期间出现3例皮肤感染坏死/延迟愈合;截至随访结束,两组病人术前术后AOFAS评分比较,差异有统计学意义(P<0.05),但两组间术后AOFAS及ATRS评分比较差异无统计学意义(P>0.05)。结论经导针引导下微创治疗跟腱断裂手术时间略长,但与常规手术比较,能有效避免术后并发症。

Minimally invasive suture for acute closed Achilles tendon rupture guided by epidural needle

Objective To investigate the clinical efficacy of minimally invasive incision on acute closed rupture of Achilles tendon guided by epidural needle.Methods A retrospective case series study was conducted to analyze the operative outcome of 29 patients with Achilles tendon rupture.They were randomly divided into observation group(minimally invasive incision group)and control group(conventional incision group)with 16 and 13 respectively.The interval between injury and operation ranged from 0.5 h to 5 days.All patients were treated with personalized plaster fixation after surgery,and performed functional exercise for 1~2 months.After one year follow-up at least,the operative time、postoperative complications(wound infection,sural nerve injury,Achilles tendon re-rupture)、AOFAS score and ATRS score in two groups were compared.Results Compared with the conventional group(48.91±12.56)min],the mean operative time of the minimally invasive group(41.78±9.56)min] was slightly longer,but there was no significant difference(P>0.05).During the follow-up,no postoperative sural nerve injury or Achilles tendon re-rupture occurred in both group,and 3 cases of skin infection and necrosis/delayed healing occurred in the conventional group.By the end of the follow-up,the AOFAS scores of the two groups were significantly improved(P<0.05),but there was no difference in the AOFAS and ATRS scores between the two groups(P>0.05).Conclusion The duration of minimally invasive incision in the treatment of Achilles tendon rupture under the guidance of epidural needle is slightly longer,but compared with the conventional surgery,it can effectively avoid post-operative complications.