缝线锚钉修复跟腱近止点断裂的疗效评价

目的:探讨应用缝线锚钉修复跟腱近止点断裂的可行性、手术技巧与临床疗效。方法:回顾性分析自2005年6月至2008年8月应用缝线锚钉修复的16例跟腱近止点断裂患者的临床资料。其中,男13例,女3例;年龄17～46岁,平均33.5岁。术后不同时期对患者进行不同内容的康复训练。对手术时间、锚钉置入位置和术中术后并发症等进行分析,采用Arner-Lindholm标准对跟腱功能恢复情况进行评估。结果:平均随访时间13.2个月,所有患者均获得随访,无异物反应、跟腱再断裂等。平均手术时间35.5min,术中均无医源性神经、血管、肌腱等损伤。16例共置入缝线锚钉19枚,其中1枚置偏。跟腱功能恢复情况:优13例,良2例,差1例。随访工作及生活满意,X线均未见锚钉移位。结论:应用缝线锚钉修复跟腱近止点断裂,手术简捷、固定确实、疗效优良、并发症低,是一种较可靠而有效的治疗方法。     

缝线锚钉与钻孔缝合修复股四头肌髌骨止点断裂的疗效比较

目的 比较缝线锚钉与钻孔缝合修复股四头肌髌骨止点断裂的疗效。 方法回顾性分析2000年1月至2008年10月采用缝线锚钉法或钻孔缝合法治疗的42例股四头肌髌骨止点断裂患者资料,根据患者收治时间段及修复方法不同分为两组：传统组（采用钻孔缝合修复）21例,男18例,女3例;平均年龄(27.0±6.2)岁（19 ～41岁）。锚钉组(采用缝线锚钉修复)21例,男16例,女5例;平均年龄(24.0±5.4)岁（16 ～ 37岁）。比较两组患者的手术时间、切口长度、出血量及外固定时间等,并采用Lysholm评分标准和美国膝关节协会评分(KSS)标准对膝关节功能进行评定。 结果 42例患者术后获2～3年（平均2.7年）随访。两组患者在手术时间、切口长度、出血量、外固定时间及髌骨位置方面差异均有统计学意义(P＜0.05)。两组患者切口均一期愈合,传统组14例患者于术后1年手术取出钢丝;锚钉组未再次手术,末次随访时锚钉位置正常。传统组膝关节功能Lysholm评分平均为(90.0±8.7)分,锚钉组平均为(95.0±4.5)分,两组比较差异无统计学意义(t=-1.333,P=0.190)。按KSS评分标准评定疗效：传统组优8例,良8例,可5例,优良率为76.2％;锚钉组优14例,良5例,可2例,优良率为90. 5％。 结论缝线锚钉与钻孔缝合修复股四头肌髌骨止点断裂均可取得满意疗效。相比较而言,缝线锚钉创伤小、操作简便、固定效果更好,可以早期开始功能锻炼,是治疗股四头肌髌骨止点断裂的一种较好方法。     

缝线锚钉修复跟腱近止点断裂的中短期疗效

目的 探讨应用缝线锚钉修复跟腱近止点断裂的手术技巧和中短期临床疗效.方法 2005年6月至2009年12月应用缝线锚钉修复22例跟腱近止点断裂患者,男16例,女6例;年龄16～51岁,平均35.5岁.对手术时间、锚钉置入位置和术中术后并发症等进行分析,采用Arner-Lindholm标准对末次随访时跟腱功能恢复情况进行评估.结果 所有患者获平均24.1个月(12～35个月)随访.其中1例患者出现钉尾刺激症状,无异物反应、跟腱再断裂等发生;平均手术时间35.5 mim,术中均未发生医源性神经、血管、肌腱等损伤.22例患者共置入缝线锚钉27枚,其中2枚(7.4%)置入过浅,1枚(3.7%)置偏.Arner-Lindholm标准评价功能:优18例,良3例,差1例,优良率为95.5%.随访过程中患者对工作及生活满意,X线均未见锚钉移位.结论 应用缝线锚钉修复跟腱近止点断裂,操作简捷、固定确实、疗效优良、并发症低,是一种可靠而有效的治疗方法,值得推广.     

单缝线锚钉双Kssler法治疗新鲜跟腱断裂

[目的]探讨单缝线锚钉双Kessller法治疗新鲜跟腱近止点断裂的疗效.[方法]对21例跟腱近止点断裂患者,采用单锚钉缝线双Kessller法缝合,术后短腿石膏固定6周.[结果]全部病例得到随访,有1例开放性跟腱断裂伤 口感染,根据Amer-Lindholm评分标准,本组病例优17例,良4例,优良率100％,全部无锚钉松脱、足跟疼痛及跟腱再次断裂发生.[结论]单缝线锚钉双Kessller法治疗急性跟腱断裂效果良好.     

锚钉在跟腱断裂修复中的应用

目的探讨应用强生Fastin锚钉治疗跟腱断裂的临床效果。方法 18例新鲜跟腱断裂患者,断裂平面距止点平均1.5（0-2.5）cm。手术取跟腱内侧纵形切口,暴露跟腱断端,修整后在跟骨结节跟腱止点处置入强生Fastin带线锚钉,用锚钉上连接的Ethibond-2号缝线缝合断裂跟腱。结果 18例均获得随访,平均13（8-15）个月。术后X线片未见骨锚松动或脱落。按Arner-Lindholm标准评定疗效,优14例,良3例,差1例,优良率94.4%。结论 Fastin锚钉治疗止点附近跟腱断裂临床效果满意,具有肌腱修复可靠、操作简单、术后并发症少的优点,具有良好的应用前景。     

带线锚钉半Kessler缝合法修复自发性跟腱断裂

目的探讨利用带线锚钉半Kessler缝合法修复自发性跟腱断裂的临床效果。方法 2011年1月-2013年12月采用带线锚钉半Kessler缝合法修复自发性跟腱腱性部位断裂患者31例。其中男23例,女8例;年龄16~53岁,平均38岁。左足15例,右足16例。致伤原因:体育运动中突发足跟部疼痛、行走无力22例,下楼踩空、滑倒、搬重物等原因9例。断裂部位距离跟骨止点3~6 cm,平均4.2 cm。受伤至手术时间为7 h~4 d,平均36.8 h。结果所有患者切口均Ⅰ期愈合,无腓肠神经损伤表现,跟腱修复部位与皮肤无粘连。31例患者均获随访,随访时间6~24个月,平均15个月。术后6个月所有患者均可顺利完成25次提踵活动;随访期间无跟腱再断裂发生。术后6个月健、患侧踝关节背伸及跖屈范围比较差异均无统计学意义(t=0.648,P=0.525;t=0.524,P=0.605)。术后6个月患侧小腿最大周径明显小于健侧(t=2.074,P=0.041),但术后12个月健、患侧比较差异无统计学意义(t=0.905,P=0.426)。术后6、12、18、24个月患者美国矫形足踝协会(AOFAS)评分均显著高于术前(P0.05);术后除6个月评分低于其余各时间点(P0.05)外,其余各时间点间差异均无统计学意义(P0.05)。结论带线锚钉半Kessler缝合法修复自发性跟腱断裂,不但可提供强大的修复拉力,而且降低了缝线对肌腱的切割力,是一种可供选择的良好修复方法。     

缝线锚钉修复腱性组织止点区断裂伤的失效原因分析

目的 通过对缝线锚钉修复腱性组织止点区断裂伤的失效原因进行分析,旨在提高此类内固定修复腱性组织止点区断裂的疗效,减少锚钉失效的发生率.方法 2006年6月至2008年6月,对收治的7例应用缝线锚钉治疗腱性组织止点区断裂失效患者进行回顾性研究,其中男5例,女2例;年龄22～64岁,平均41岁.跟腱断裂2例,肩袖撕裂1例,喙锁韧带断裂1例,髌韧带撕脱1例,膝内侧副韧带断裂1例,胫前肌腱止点处断裂1例.7例患者于伤后5 h～4个月行切开腱性组织修复术,锚钉类型为强生GⅡ快速增强缝线锚钉(形状类似倒钩)和强生FastinRC带螺纹锚钉.术后随访10d～3周发现锚钉失效.结果 7例失效患者全部为锚钉脱出,无缝线断裂及锚钉毁损,且原始损伤均为较粗大腱性组织断裂.锚钉失效原因:手术操作不当4例,锚钉选择失误2例,患者依从性差而过早活动1例.患者因患处疼痛均于术后2个月左右行锚钉取出术.结论 应用锚钉前需要对锚钉装置有详细的了解,骨质、锚钉类型、锚钉置入方向及手术技巧的掌握等都影响锚钉固定的疗效.     

应用带线锚钉修复跟腱止点处断裂临床疗效分析

<正>跟腱断裂是临床上常见的肌腱损伤,目前多采用手术治疗,直接缝合跟腱止点处断裂较困难,过去通常采用Bunnell钢丝缝合法,术后并发症较多。2012年5月~2015年10月,我们对21例跟腱止点处断裂患者采取带线锚钉缝合术治疗,临床疗效满意。现报道如下。对象与方法1.对象:跟腱止点处断裂患者21例,男17例,女4例,年龄26~48岁,平均年龄33岁。损伤原因:跑跳等运动损伤12例,     

带线锚钉在跟腱止点重建中的临床应用

目的分析应用带线锚钉重建跟腱止点的临床效果,并探讨跟腱近止点断裂的原因及治疗方法。方法应用带线锚钉结合Krackow缝合技术治疗18例跟腱近止点病变,随访采用Amer—Lindholm标准评价临床效果,记录并发症、患者恢复工作的时间、跖屈肌力、踝关节活动度、疼痛视觉评分。结果18例均获得随访平均13（8～17）个月,切口均一期愈合,无锚钉松动、移位及跟腱再次断裂。末次随访时按Amer—Lindhohn标准评价临床效果：优13例,良4例,差1例;视觉疼痛评分平均2．54（0～4）分;踝关节活动度跖屈曲平均20°（10—35°）,背屈平均5°（-5～15°）：跖屈肌力较对侧减少平均15％（8％～20％）。结论采用带线锚钉结合Krackow缝合技术蘑建跟腱止点治疗跟腱止点病变可取得满意的临床效果。     

小切口入路空心螺钉和缝线锚钉治疗后交叉韧带胫骨止点撕脱骨折的比较

背景：随着建筑伤、车祸伤患者的增多,后交叉韧带（posterior cruciate ligament,PCL）胫骨止点撕脱骨折在临床上日益多见,多数患者需手术治疗。目前,有关小切口入路空心螺钉和缝线锚钉手术方法的报道较少。目的：比较采用空心螺钉和缝线锚钉治疗PCL胫骨止点撕脱骨折的临床疗效。方法：2008年4月至2010年4月共收治30例急性PCL胫骨止点撕脱骨折患者,12例采用空心钉固定,18例采用缝线锚钉固定。所有手术由同一组医师完成,对比观察两组的疗效及手术时间。结果：全部获得随访,随访时间为6～24个月,平均为11.3个月,所有患者均获骨性愈合。术后X线片示空心螺钉组2例未能解剖复位,缝线锚钉组全部解剖复位。每组各2例进行后抽屉试验1＋,所有患者伸膝正常,空心螺钉组1例屈膝受限10°。Lysholm评分空心螺钉组为88～100分,平均95.8分;缝线锚钉组为87～99分,平均96.1分,两组无统计学差异（P=0.495）;手术时间空心螺钉组为35～60min,平均48min,缝线锚钉组为30～45min,平均36min,有统计学差异（P=0.03）。结论：空心螺钉和缝线锚钉治疗PCL胫骨止点撕脱骨折均可达到满意疗效,缝线锚钉的手术时间更短,骨折复位更满意。     

Anatomical repair of distal biceps brachii tendon rupture through a limited anterior approach

To avoid the extended anterior or the two-incision approach to the radius, we present a limited anterior approach for anatomical reattachment at the radial tuberosity of the distal biceps brachii tendon complete rupture using suture anchors. Our clinical experience in nine patients showed that secure fixation obtained with the suture anchors, limited surgical approach and anatomical reconstruction allow for early mobilization and rapid return of function, and provide excellent long-term results with acceptable complications. We suggest using the limited anterior approach in patients with early (less than 6 weeks) distal biceps brachii tendon rupture.     

Operative repair of neglected rupture of the tendo Achillis

An operation to reconstruct a neglected rupture of the tendo achillis is described using the aponeurosis of the gastrocnemius-soleus muscle fashioned into a tube. The repair is strong and effective and has given good results in five patients.     

Acute proximal hamstring rupture

Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and most series have had a relatively small number of patients. Surgical repair results project 58% to 85% rate of return to function and sports activity, near normal strength, and decreased pain.     

Patient-oriented functional outcome after repair of distal biceps tendon ruptures using a single-incision technique

Using a patient-oriented outcome questionnaire, in addition to standard outcome measures, we sought to determine the outcome of patients who had repair of a complete rupture of the distal biceps tendon via a single anterior incision technique with suture anchors. We identified 62 patients who were treated operatively by a single surgeon over an 8-year period for a diagnosis of complete rupture of the distal biceps tendon. Of the patients, 9 could not be located for final follow-up, and 53 of 62 (85%) participated in the study. All patients were men, and their mean age was 42 years. All repairs were performed via a single anterior incision by use of 2 suture anchors in the bicipital tuberosity on an outpatient basis. There were 4 complications (4/53 [7.5%]): 1 wound infection, 2 transient paresthesias in the lateral cutaneous nerve distribution, and 1 posterior interosseous nerve palsy that resolved in 6 weeks (no reoperations). There were no reruptures, and no patient lost more than 5 degrees of elbow flexion- extension or forearm rotation. All patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The mean DASH score was 8.2 +/- 11.6 (95% CI, 5.2 to 11.9), which was similar to the mean DASH score in population controls of 6.2 (DASH User Manual). The strengths of our study include the consistent surgical technique by a single surgeon, the large number of patients, and the use of a patient-oriented outcome measure. Distal biceps tendon rupture repair via a single-incision technique with suture anchors was effective in restoring injured arms to normal, as measured by limb-specific patient-oriented measures, with minimal morbidity and a low complication rate.     

Complications of metallic suture anchors in shoulder surgery: A report of 8 cases

Purpose: Metallic suture anchors are widely used in open and arthroscopic operations about the shoulder. We report the cases of 8 patients who were referred to our institution with complications following shoulder surgery in which metallic suture anchors were used. Type of Study: Retrospective case series. Methods: There were 7 male patients and 1 female patient with an average age of 36 years (range, 18 to 76 years). The initial operation was open anterior reconstruction for anterior instability of the glenohumeral joint in 5 patients, open rotator cuff tear repair in 2 patients, and an open posterior capsular reconstruction for posterior instability in 1 patient. All patients were referred for evaluation after a failed index reconstructive procedure. Results: On average, 5.5 suture anchors (range, 3 to 8) per shoulder were used. Of 4 patients undergoing reconstruction with glenoid anchors only, 3 patients had an extraosseously positioned device. In this subset of glenoid-sided reconstructions, when more than 3 anchors were used, at least 1 anchor was inserted in an extraosseous position. In 2 of 3 patients with isolated humeral anchors, there was evidence of migration over time (1 intra-articular, 2 bursal). Three patients (38%) developed severe articular damage that was directly caused by a loose or intra-articular metal suture anchor. One patient developed a wound infection after reconstructive surgery. In all 8 patients, the index procedure failed and required subsequent surgery. Conclusions: The use of metallic suture anchors about the shoulder is commonplace and useful, but, as with other hardware used about the shoulder, there are significant risks if the anchors are improperly placed or if the index procedure fails.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 31–37     

Repair of distal biceps tendon rupture with suture anchors and a single anterior incision: a review of six cases

We present a retrospective review of six cases of distal biceps tendon repair with a mean follow-up of 1 year. All patients were men aged between 34 and 62 years. In all patients, the injury was sustained with application of an unanticipated large load to the flexed arm. All but one patient was operated within a week of the injury. All six cases were operated through a single anterior incision and the torn tendon ends fixed to the radial tuberosity with implantable suture anchors. All patients were reviewed subjectively and objectively. All but one returned to preinjury activity within 6 months. One patient developed superficial radial nerve neurapraxia, which recovered, and one developed a superficial wound infection, which required treatment with oral antibiotics and surgical excision of the sinus. We believe that operative repair of distal biceps tendon rupture using a single anterior incision and suture anchors is a safe and effective method of treating theses injuries.     

Single-incision repair of acute distal biceps ruptures by use of suture anchors

The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures by use of suture anchors. Sixty consecutive patients underwent distal biceps repair after an acute rupture between January 1997 and January 2001 by use of a limited antecubital incision and suture anchors. Fifty-three patients could be evaluated at a mean follow-up of 38.1 months. A limited transverse incision was made in the antecubital fossa. The retracted biceps tendon end was identified, retrieved, and lightly debrided. Two suture anchors were placed in the radial tuberosity, and the tendon was reapproximated. Final follow-up consisted of physical examination, radiographs, and Andrews-Carson elbow score tabulations. According to the Andrews-Carson scores, there were 46 excellent and 7 good results. In 2 patients, heterotopic ossification developed that resulted in a mild loss of forearm rotation and mild pain. In 1 patient, a temporary radial nerve palsy developed, which resolved completely within 8 weeks. Repair of acute distal biceps tears via a limited antecubital incision and suture anchors is a safe, effective technique.     

Late reconstruction of chronic distal biceps tendon ruptures using fascia lata autograft and suture anchor fixation

Distal biceps tendon ruptures are a rare injury, and surgical reconstruction is typically recommended for chronic ruptures. There is no consensus regarding the most appropriate reconstruction technique. We present our experience with reconstruction of chronic distal biceps tendon ruptures with fascia lata autograft, secured to the bicipital tuberosity with suture anchors. A single anterior incision is used for all patients. Tension is set with the elbow in 50 degrees of flexion. Ninety-two percent of our patients reported improvement in elbow flexion and supination and were pleased with the surgery. Range of motion and isokinetic flexion and supination strength after this procedure was comparable with other distal biceps tendon reconstruction options using tendon grafts and suture anchor fixation from a single anterior approach. Furthermore, common complications associated with distal biceps tendon repair and reconstruction can be avoided with this technique. We therefore feel that this technique is a viable surgical treatment alternative with good subjective and objective outcomes.Level of Evidence: Level IV.