改良的Ma和Griffith微创经皮缝合与开放缝合术治疗急性闭合性跟腱断裂的临床分析

目的评价经皮缝合与开放缝合治疗闭合性跟腱断裂的疗效。方法回顾性研究2006年3月～2009年6月期间随机选取的44例新鲜闭合性跟腱断裂病例,其中通过改良的Ma和Griffith方法经皮缝合（改良组）治疗17例,男15例,女2例;平均年龄37.3岁。切开手术缝合（开放组）治疗27例,均为男性,平均年龄38.6岁,随访比较两种手术的平均手术时间、术中出血量、平均住院费用、平均住院时间、术后镇痛药使用率、并发症及功能恢复情况。结果两组间的平均手术时间、术中出血量、平均住院费用、平均住院时间、术后镇痛药使用率比较,差异均有统计学意义（p〈0.05）。开放组1例术后6个月滑倒时再次断裂,二次开放手术缝合;3例出现伤口渗液,延迟愈合。改良组伤口均I期愈合。44例患者术后平均获21.2个月（6～39个月）随访。按Arner-Lindholm疗效评定标准：改良组优15例,良2例,优良率为100%;开放组优18例,良6例,差3例,优良率为88.9%,差异有统计学意义。结论与开放缝合术比较,改良的Ma和Griffith微创经皮缝合治疗新鲜闭合性跟腱断裂,恢复快、手术并发症少、效果好,是目前治疗新鲜闭合性跟腱断裂的较好选择。

Efficancy comparison between percutaneous and open tenorrhaphy tot Achilles tendon rupture

Objective To evaluate the efficancy of percutaneous and open tenorrhaphy for Achilles tendon rupture.Methods 44 patients with spontaneous ruptures of the Achilles tendon underwent percutaneous repair（17 cases） or open tenorrhaphy（27 cases） from March 2006 to June 2009.A modification of the technique described by Ma and Griffith was used in the percutaneous group.The mean age was 37.3 years.15 patients were male and 2 female.A Kessler suture supplemented with interrupted sutures was used in the open group.The mean age was 38.6 years.All patients were male.Complications,postoperative recovery state,time of operation,intraoperative bleeding volume,mean cost of hospitalization,average length of stay,postoperative analgesic usage,were compared in the follow-up.Results There were significant differences（p〈 0.05） between the two groups in the time of operation,intraoperative bleeding volume,mean cost of hospitalization,average length of stay,postoperative analgesic usage.There were no infection or skin necrosis in percutaneous group,otherwise there were 1 rerupture 6 months postoperatively,necroses in 3 cases and 1 needed second debridment in the open group.All patients attended the mean follow-up of 21.2 months.According to Arner-Lindholm criteria,18 cases had excellent results,6 good results,and 3 cases had unsatisfied results,with the excellent and good rate being 88.9% in the open treatment group;15 cases had excellent results and 2 good results,with the excellent and good rate being 100% in percutaneous treatment group.Conclusion Percutaneous repair of the Achilles tendon is advocated on the basis of the low rate of complications and improved cosmetic appearance.