微创跟腱吻合器与改良Kessler法缝合治疗急性跟腱断裂的治疗对比

目的比较跟腱断裂采用微创跟腱吻合器治疗与改良Kessler法缝合治疗的效果。方法对2007年7月~2011年7月本院收治的55例急性闭合性跟腱断裂患者的疗效进行回顾对照研究,分为微创跟腱吻合器组和改良Kessler组,其中采用微创跟腱吻合器治疗34例,采用改良Kessler法缝合治疗21例,术后石膏固定4~6周,同时进行功能锻炼,随访术后疗效及并发症。结果 55例全部随访,随访时间不少于12个月,两组之间跟腱再断裂和术后粘连差异无统计学意义（P〉0.05）,而改良Kessler组的切口感染和切口愈合不良发生率较微创吻合器组高（P〈0.05）。AFOAS评分在术后12周内微创吻合器组较高（P〈0.05）,而12周以后两组间差异无统计学意义（P〉0.05）。术后早期患者对微创吻合器的满意率较高。结论临床上这两种缝合方法都能取得良好的疗效,相比于改良Kessler法,微创吻合器法切口小,并发症少,更能使患者满意,但使用微创吻合器法时需考虑到患者的经济因素。

Mini-invasive surgical anastomat versus modified Kessler method in treating rupture of Achilles tendon

Objective To compare the clinical effects of the treatment of acute closed Achilles tendon rupture by using mini-invasive surgical anastomat and modified Kessler method.Methods 55 cases of acute closed Achilles tendon rupture were reviewed from July 2007 to July 2010 in our hospital,divided into mini-invasive surgical anastomat group and modified Kessler method group.34 cases for the former group,and 21 for the later one.All ruptures were immobilized on legs by plaster cast after the operation for four to six weeks.Meanwhile,functional training was performed.Postoperative outcomes and complications were followed up.Results All the 55 cases were followed up for at least 12 months,There was no statistical difference in the rates of rerupture and postoperative adhesion(P > 0.05) between the two groups,but the rates of incision infection and poor incision healing in the modified Kessler group was higher than in the other group(P < 0.05).AFOAS score in mini-invasive surgical anastomat group was higher than that in Kessler method group within 12 weeks postoperation,with statistical difference(P < 0.05).There was no statistical difference in AFOAS score between the two groups since 12 weeks postoperation(P > 0.05).Patient′s satisfaction rate in mini-invasive surgical anastomat group was higher than that in Kessler method group in early stage.Conclusion Both suturing treatments for closed rupture of the Achilles tendon have good clinical results.Compare to modified Kessler method,using Mini-invasive surgical anastomat for rupture of Achilles tendon is a satisfied operation with small wound and less complications.However the economic fact should not be ignored.