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摘要 目的 比较带线铆钉微创缝合与常规切开缝合治疗急性跟腱断裂的疗效。方法 回顾性分析2015年4月至2018年8月海军军医大学第一附属医院行手术治疗的103例急性跟腱断裂患者资料。采用带线铆钉微创缝合治疗(微创组)59例,其中男58例,女1例,年龄35(30,37)岁。采用常规切开缝合治疗(切开组)44例,其中男40例,女4例,年龄33(30,38)岁。比较两组手术时间、切口长度、失血量、患者满意度、住院费、拆线时间、术后制动时间、手术至拄拐行走和正常行走时间,术后早期和远期并发症发生率以及二次手术率等疗效评价指标。结果 两组患者基线特征数据比较差异无统计学意义(P>0.05)。随访时间19(17,25)个月。微创组切口长度小于切开组(P<0.05),患者满意度高于切开组,差异有统计学意义(P<0.05);两组失血量、手术时间、住院费用比较,差异无统计学意义(P>0.05)。微创组患者拆线时间、术后制动时间、手术至拄拐行走和正常行走时间均显著小于切开组,差异有统计学意义(P<0.05)。两组患者术后早期并发症发生率、远期并发症发生率以及二次手术率比较,差异均无统计学意义(P>0.05)。结论 相比常规切开缝合,带线铆钉微创缝合技术治疗急性跟腱断裂切口小、术后康复快、患者满意度高,且未增加并发症发生率。
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关键词 :
跟腱,
腱损伤,
外科手术,
微创性
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通讯作者:
张欣
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作者简介: 凡杰夫(2000- ),男,本科在读,海军军医大学,fanjf6382018037@163.com。 |
[1]Suchak AA,Bostick G,Reid D,et al.The incidence of Achilles tendon ruptures in Edmonton,Canada[J].Foot Ankle Int,2005,26(11):932-936.
[2]Lemme NJ,Li NY,Kleiner JE,et al.Epidemiology and video analysis of achilles tendon ruptures in the national basketball association[J].Am J Sports Med,2019,47(10):2360-2366.
[3]Ochen Y,Beks RB,van Heijl M,et al.Operative treatment versus nonoperative treatment of Achilles tendon ruptures:Systematic review and meta-analysis[J].BMJ,2019(364):k5120.
[4]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(17):2767-2775.
[5]刘培钊,章浩,纪方.急性跟腱断裂治疗方法的研究进展[J].实用骨科杂志,2017,23(1):36-41.
[6]向成浩,黄涛,谭晓蓉,等.应用同种异体肌腱治疗Kuwade Ⅲ、Ⅳ型陈旧性跟腱断裂[J].实用骨科杂志,2021,27(8):699-703.
[7]Wang CC,Chen PY,Wang TM,et al.Ultrasound-guided minimally invasive surgery for achilles tendon rupture:Preliminary results[J].Foot Ankle Int,2012,33(7):582-590.
[8]姚兴璋,李兴勇,蒋振兴,等.经皮微创锚钉缝合修复急性闭合性跟腱断裂的临床疗效[J].中华创伤杂志,2018,34(6):521-526.
[9]Gatz M,Driessen A,Eschweiler J,et al.Open versus minimally-invasive surgery for Achilles tendon rupture:A meta-analysis study[J].Arch Orthop Trauma Surg,2021,141(3):383-401.
[10]Stein SR,Luekens CJ.Closed treatment of Achilles tendon ruptures[J].Orthop Clin North Am,1976,7(1):241-246.
[11]Magnussen RA,Dunn WR,Thomson AB.Nonoperative treatment of midportion Achilles tendinopathy:A systematic review[J].Clin J Sport Med,2009,19(1):54-64.
[12]Maempel JF,Clement ND,Wickramasinghe NR,et al.Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management[J].Bone Joint J,2020,102-B(7):933-940.
[13]Fearon KC,Ljungqvist O,Von Meyenfeldt M,et al.Enhanced recovery after surgery:A consensus review of clinical care for patients undergoing colonic resection[J].Clin Nutr,2005,24(3):466-477.
[14]Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[15]杨明,张晓萌,张殿英,等.两种微创技术治疗跟腱断裂的比较研究[J].中华创伤骨科杂志,2016,18(3):192-196.
[16]Bhattacharyya M,Gerber B.Mini-invasive surgical repair of the Achilles tendon:Does it reduce post-operative morbidity?[J].Int Orthop,2009,33(1):151-156.
[17]Zandbergen RA,de Boer SF,Swierstra BA,et al.Surgical treatment of achilles tendon rupture:Examination of strength of 3 types of suture techniques in a cadaver model[J].Acta Orthop,2005,76(3):408-411.
[18]Vega J,Baduell A,Malagelada F,et al.Endoscopic achilles tendon augmentation with suture anchors after calcaneal exostectomy in haglund syndrome[J].Foot Ankle Int,2018,39(5):551-559.
[19]Obut S,Gultekin A,Unal M,et al.A simple suture-guiding device for minimally invasive Achilles tendon repair[J].J Orthop Surg (HK),2017,25(3):613399772.
[20]Meta Mark-Christensen T,Troelsen A,Kallemose T,et al.Functional rehabilitation of patients with acute Achilles tendon rupture:A meta-analysis of current evidence[J].Knee Surg Sports Traumatol Arthrosc,2016,24(6):1852-1859.
[21]Kauwe M.Acute achilles tendon rupture:Clinical evaluation,conservative management,and early active rehabilitation[J].Clin Podiatr Med Surg,2017,34(2):229243.
[22]齐月宾,安宇,玉光哲,等.急性跟腱断裂修复术后短腿石膏托固定的可行性研究[J].实用骨科杂志,2016,22(2):139-141.
[23]Calder JD,Saxby TS.Early,active rehabilitation following mini-open repair of Achilles tendon rupture:A prospective study[J].Br J Sports Med,2005,39(11):857-859.
[24]Braunstein M,Baumbach SF,Boecker W,et al.Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair[J].Knee Surg Sports Traumatol Arthrosc,2018,26(3):846-853.
[25]Enwemeka CS.Functional loading augments the initial tensile strength and energy absorption capacity of regenerating rabbit Achilles tendons[J].Am J Phys Med Rehabil,1992,71(1):31-38.
[26]张斌,杨晓斐,杨志刚,等.带线铆钉结合改良Krackow缝合法治疗跟腱断裂的临床疗效[J].江苏医药,2016,42(16):1836-1837.
[27]Nilsson-Helander K,Silbernagel KG,Thomeé R,et al.Acute achilles tendon rupture:A randomized,controlled study comparing surgical and nonsurgical treatments using validated outcome measures[J].Am J Sports Med,2010,38(11):2186-2193.
[28]梁晓军,赵宏谋,李毅,等.微创手术与传统手术治疗急性跟腱断裂的比较研究[J].中国骨与关节外科,2013(5):438-441.
[29]Bonchek LI.Prevention of endothelial damage during preparation of saphenous veins for bypass grafting[J].J Thorac Cardiovasc Surg,1980,79(6):911-915. |
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