改良小切口双津下缝合法治疗急性跟腱断裂

目的探讨改良小切口双津下缝合法治疗急性跟腱断裂的临床疗效。方法采用改良小切口双津下缝合法治疗27例急性跟腱断裂患者。记录手术相关指标、住院天数和术后并发症发生情况。术后3、6个月采用Arner-Lindholm跟腱功能和AOFAS踝-后足功能评分评价疗效。结果患者在术后3、6个月均获得随访。切口均一期愈合,术后均无二次断裂、切口感染及腓肠神经损伤发生。Arner-Lindholm跟腱功能评分优良率:术后3个月为74. 1%(20/27),术后6个月为92. 6%(25/27)。AOFAS踝-后足评分:术前1 d为28～46(32. 2±12. 5)分,术后3个月为75～94(84. 2±8. 4)分,术后6个月为92～100(95. 2±5. 1)分。结论改良小切口双津下缝合法修复急性跟腱断裂可减少术后切口皮缘坏死和跟腱粘连的发生,踝关节活动恢复好,创伤小,康复快,临床疗效满意。     

急性闭合性跟腱断裂的微创手术治疗

目的 探讨采用Achillon行微创缝合治疗急性跟腱断裂的临床疗效. 方法 2010年12月至2011年5月收治7例7足急性跟腱断裂患者,男5例,女2例;年龄21～53岁,平均34 2岁.均为闭合性损伤,受伤至手术时间为1～11 d,平均3.8d.手术切口在跟腱断裂处内侧行2.0～3.5 cm长切口,以Achillon插入行微创手术缝合跟腱断端.术后康复锻炼.结果 所有患者伤口均获Ⅰ期愈合,所有患者获5～11个月(平均7.2个月)随访.术后3个月时患者均正常下地负重,无再发跟腱断裂,美国足踝外科协会(AOFAS)踝与后足评分93.2分,患处疼痛的视觉模拟评分为1.2分.结论 对急性跟腱断裂采用Achillon行微创手术缝合具有损伤小,并发症少,恢复快等优点,是跟腱修复方法的较好选择.     

小切口加可吸收线缝合治疗闭合性跟腱断裂

[目的]探讨治疗闭合性跟腱断裂手术新方法,减少术后发生皮肤坏死.[方法]采用小切口加可吸收线(1-0普迪斯)在跟腱近侧断端行Bunnell缝合、远端行腱皮缝合,治疗39例闭合性跟腱断裂患者.[结果]39例中3例发生少许皮肤坏死,其中2例换药后愈合,1例经清创缝合后愈合.随访35例,时间10～36个月,平均时间23个月,按照Arner-Lindholm疗效评定标准,优29例 (82.9%),良4例(11.4%),优良率达94.3%.[结论]小切口加可吸收线在跟腱近端断端行Bunnell缝合,远端腱皮缝合,对合可靠,创伤小,对皮肤血供影响小,发生皮肤坏死的可能性小,再断裂及感染机会少,功能恢复快,是治疗闭合性跟腱断裂的较好方法.     

套索锁扣结立体缝合法修复急性撕裂型跟腱断裂

目的总结自行设计的套索锁扣结立体缝合法修复急性撕裂型跟腱断裂的临床应用及体会。方法 2006年1月-2010年6月,收治41例运动损伤致急性撕裂型跟腱断裂患者。男33例,女8例;年龄18～56岁,平均41岁。均为单侧闭合性损伤;左足27例,右足14例。其中33例可触及明显断裂缺损区,7例行B超检查辅助明确诊断,1例行MRI检查确诊。损伤至手术时间为36h～7d。患者均采用套索锁扣结立体缝合法修复。结果术后切口均Ⅰ期愈合。31例获随访,随访时间1年～3年10个月,平均17个月。术后1年随访,患者肌力5级,行走正常,提踵有力。患侧与健侧小腿周径差均<3cm,踝关节背伸20～30°,跖屈40～50°。随访期间无跟腱再断裂及深部感染等并发症发生。末次随访时按Arner-Lindholm疗效评定标准,获优21例,良10例,优良率为100%。结论采用套索锁扣结立体缝合法修复急性撕裂型跟腱断裂具有把持力强、抗张强度大、对跟腱血运影响小等优点,是一种安全、有效的方法。     

双津下套圈缝合法与跟腱龙技术治疗急性跟腱断裂的比较

[目的]为比较两种微创手术治疗急性跟腱断裂的临床结果。[方法]共计140例患者纳入本研究,其中101例采用津下技术,39例采用跟腱龙技术修复跟腱。记录手术时间、住院天数、并发症等情况,并采用AOFAS踝-后足疗效评价及ATRS跟腱断裂评分评定术后疗效。[结果]津下组手术时间及住院天数短于跟腱龙组,差异有统计学意义(P0.05)。津下组患者总体并发症发生率为1%,仅有1例再断裂,无感染、腓肠神经损伤、皮肤粘连等并发症。跟腱龙组术后总体并发症发生率为10%,其中,腓肠神经损伤1例,切口感染1例,跟腱粘连1例,1例术后1个半月因肺栓塞去世。138例患者获得随访,随访时间6个月～3年。两组患者ATRS和AOFAS评分均随时间延长而增高,并且不同时间点差异有统计学意义(P0.05)。术后6月和术后1年时,津下组评分较跟腱龙组评分高(P0.05),术后3年时,津下组评分与跟腱龙组评分差异无统计学意义(P0.05)。[结论]小切口双津下缝合法和跟腱龙手术均为微创手术,具有切口小、愈合快、并发症少等优点。与跟腱龙手术相比,小切口双津下套圈缝合法术后早期效果更好。     

后内侧入路结合皮内缝合治疗跟腱断裂

目的探讨后内侧入路结合可吸收线皮内缝合治疗跟腱断裂的疗效.方法：采取后正中旁内侧入路结合可吸收线皮内缝连续合治疗闭合跟腱断裂43例,观察术后皮缘坏死率、感染率及术后6个月切口瘢痕愈合情况.结果：43例术后随访10～22个月,平均15个月;1例术后10周再次拉伤,42例切口愈合好、瘢痕小,根据Arner-Lindholm疗效评定标准,优38例,良4例,差1例,优良率98%.结论：采用后正中旁内侧入路结合可吸收线皮内缝连续合治疗跟腱断裂,切口愈合好、瘢痕小、皮缘坏死及切口感染发生率低.     

小切口微创技术治疗急性闭合性跟腱断裂

目的:探讨采用小切口行微创缝合治疗急性闭合性跟腱断裂的临床效果。方法:2012年4月至2013年10月,对14例14足急性闭合性跟腱断裂的患者采用小切口微创技术修复跟腱,其中男9例,女5例;年龄25～49岁,平均30.5岁;受伤至手术时间1～13 d,平均8 d.在跟腱断裂处正中偏内侧行1.5～2.0 cm小切口,用卵圆钳导入缝针,微创缝合修复跟腱断裂。术后常规康复锻炼。结果:14例中2例创口局部持续渗出,经换药好转,其余均Ⅰ期愈合。所有患者获随访,时间6～24个月,平均11个月。美国足踝外科协会(AOFAS)踝与后足评分92.71±6.58(82～100分).结论:小切口微创修复急性闭合性跟腱断裂损伤小,并发症少,恢复快,操作简单,适合在基层医院开展。     

小切口Kessler缝合法治疗新鲜闭合性跟腱断裂

目的 探讨应用小切口Kessler缝合法治疗新鲜闭合性跟腱断裂的临床疗效.方法2005年1月至2007年12月共收治37例新鲜闭合性跟腱断裂患者,男22例,女15例;年龄21～59岁,平均41.3岁.跟腱断裂部位:止点断裂8例,断端距止点<1.5 cm 5例,体部断裂20例,断端距止点3～6 cm 4例.37例患者均于伤后7 d内(平均4.6 d)采用小切口Kessler缝合法治疗,术后早期进行功能锻炼.根据Arner-Lindholm评分标准评定疗效.结果 37例患者术后获18～36个月(平均27个月)随访.术后无切口表浅或深部感染、皮缘坏死等并发症发生,无跟腱再断裂.术后疗效根据Arner-Lindholm评分标准评定:优30例,良7例,优良率为100%.结论应用小切口暴露方法修复新鲜跟腱断裂并结合早期功能锻炼可获得满意的临床疗效.     

小切口非对端缝合器修复急性闭合性跟腱断裂的近期疗效

目的探讨采用小切口非对端缝合器修复急性闭合性跟腱断裂的近期疗效。方法自行设计小切口非对端缝合器,并于2011年9月-2013年9月临床用于治疗22例符合选择标准的急性闭合性跟腱断裂患者。男16例,女6例;年龄22~55岁,平均32.6岁。左侧12例,右侧10例。致伤原因:运动伤16例,局部暴力致伤4例,高处坠落伤2例。MRI检查示跟腱远侧断端距跟骨结节距离40~70 mm,平均35 mm。受伤至手术时间0.5~7.0 d,平均4.2 d。术中于跟腱起点处作长约4 cm切口,置入小切口非对端缝合器夹持跟腱止点,引入2根不可吸收缝线将断端对合缝合。术后石膏托外固定6周。结果术后切口均Ⅰ期愈合,均未出现腓肠神经损伤、切口感染并发症。22例均获随访,随访时间8~14个月,平均11个月。术后8个月按Arner-Lindholm疗效评定标准:获优19例,良3例。随访期间均无跟腱再次断裂发生。结论采用小切口非对端缝合器修复急性闭合性跟腱断裂安全,术后患者可早期行功能锻炼,近期疗效满意。     

经通道辅助缝合系统微创修复急性闭合跟腱断裂的疗效观察

目的探讨经通道辅助缝合系统(channel-assisted minimally invasive repair,CAMIR)微创修复急性闭合跟腱断裂的疗效。方法 2011年1月-2012年6月,收治30例(30侧)急性闭合跟腱断裂患者。男18例,女12例;年龄22~50岁,平均30.4岁。左侧10例,右侧20例。均为运动损伤。B超检查示跟腱完全断裂;断端距跟骨止点2~8 cm,平均4.4 cm。受伤距手术时间3 h~9 d,中位时间4 d。术中在CAMIR辅助下采用改良Bunnel缝合法修复断裂跟腱。结果手术时间10~25 min,平均17.0 min;切口长1.5~2.5 cm,平均2.0 cm。术后切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓形成、腓肠神经损伤及跟腱再断裂等并发症发生。患者均获随访,随访时间12~24个月,平均16个月。末次随访时患者行走正常,提踵有力,均恢复至跟腱断裂前活动水平。MRI示跟腱愈合、连续;患侧与健侧小腿周径差均小于1 cm,踝关节背伸20~30°、跖屈20~30°。按照Arner Lindholm疗效评定标准,获优28例,良2例,优良率100%。结论 CAMIR辅助微创修复急性闭合跟腱断裂具有对合可靠、创伤小、再断裂及感染率低等优点,最大限度避免了腓肠神经损伤的发生。     

A Preliminary Study on the Effects of Acellular Tissue Graft Augmentation in Acute Achilles Tendon Ruptures

Acute Achilles tendon rupture injuries present surgical challenges because of the mechanical forces placed on this tendon. The purpose of this study was to evaluate the effectiveness of an acellular human dermal tissue matrix, GraftJacket Matrix (Wright Medical Technology, Inc., Arlington, TN), as an augmentation material in acute Achilles tendon repair. Eleven consecutive patients with acute tendon ruptures were evaluated and followed up (20-31 months). Primary repair was followed by augmentation with the graft sutured circumferentially around the tendon. Patients were placed in an early functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20-month postoperative follow-up, there have been no cases of rerupture or recurrent pain. The average return-to-activity time was 11.8 +/- 0.75 weeks. These retrospective clinical results suggest that with an acellular human dermal tissue matrix to augment acute Achilles tendon, primary repair offers a desirable return-to-activity time without any rerupture or complications. ACFAS Level of Clinical Evidence: 2c.     

A systematic review of the patient reported outcome measures utilized in level 1 randomized controlled trials involving achilles tendon ruptures

BackgroundPatient Reported Outcome Measures (PROMs) are utilized in level 1 randomized controlled trials involving Achilles tendon ruptures. However, the characteristics of these PROMs and current practices has not yet been reported. We hypothesize that there will be heterogeneous PROM usage in this context.MethodsA PubMed and Embase systematic review was performed including all dates up to July 27th, 2022, assessing Achilles tendon ruptures in level 1 studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines where applicable. Inclusion criteria were all randomized controlled clinical studies involving Achilles tendon injuries. Studies that: (1) were not level 1 evidence (including editorial, commentary, review, or technique articles), (2) omitted outcome data or PROMs, (3) included injuries aside from Achilles tendon ruptures, (4) involved non-human or cadaveric subjects, (5) were not written in English, and (6) were duplicates were excluded. Demographics and outcome measures were assessed in the studies included for final review.ResultsOut of 18,980 initial results, 46 studies were included for final review. The average number of patients per study was 65.5. Mean follow up was 25 months. The most common study design involved comparing two different rehabilitation interventions (48 %). Twenty different outcome measures were reported including the Achilles tendon rupture score (ATRS) (48 %), followed by the American Orthopedic Foot and Ankle score Ankle-Hindfoot score (AOFAS-AH) (46 %), the Leppilahti score (20 %), and the RAND-36/Short Form (SF) − 36/SF-12 scores (20 %). An average of 1.4 measures were reported per study.ConclusionSignificant heterogeneity exists in PROM usage among level 1 studies involving Achilles tendon ruptures, which prevents meaningful interpretation of these data across multiple studies. We advocate for usage of at least the disease-specific Achilles Tendon Rupture score and a global, quality of life (QOL) survey such as the SF-36/12/RAND-36. Future literature should provide more evidence-based guidelines for PROM usage in this context.Level of evidenceLevel IV; Systematic Review     

Operative treatment of acute Achilles tendon ruptures: an institutional review of clinical outcomes

PURPOSE: To retrospectively review the clinical outcome and incidence of post-operative complications after open end-to-end repair of acute Achilles tendon ruptures. METHODS: Seventy consecutive patients (74 open Achilles tendon repairs) operated on between 1989 and 2002 were identified for inclusion in this investigation. The medical records were reviewed and patients were contacted for a follow up interview in order to survey their post-operative function. Outcome scores were calculated based on the Boyden outcome and AOFAS ankle-hindfoot scoring systems. Post-operative complications were documented during the chart review and follow up interview, including an additional nine patients (nine repairs), who were not included in the clinical evaluation portion of the study. RESULTS: Fifty-two patients (54 repairs) were successfully contacted and completed the follow up interview. Within this cohort there were 44 males and 8 females with a mean age of 41 years. Achilles tendon rupture in this population was attributable to participation in athletic activity in 87% of cases. At a mean post-operative follow up of 45 months, 96% of cases achieved an overall Boyden outcome score of good to excellent. The mean AOFAS ankle-hindfoot score was 96, with 74% of cases scoring greater than 90. Forty-two cases (78%) reported no pain and 40 cases (74%) reported no activity limitations. Fourteen post-operative complications were identified after 83 open Achilles tendon repairs, resulting in an institutional complication rate of 16.8%. The complications included four superficial wound infections, five deep wound infections requiring irrigation and debridement, one heel ulcer secondary to post-operative boot wear, three partial Achilles tendon re-ruptures, and one complete Achilles tendon re-rupture. CONCLUSION: Our results demonstrate that open end-to-end repair of acute Achilles tendon ruptures provides long-term functional outcomes with consistent good to excellent results. However, this high clinical success rate was associated with a relatively high incidence of post-operative complications. With careful attention to the surgical wound and patient adherence to post-operative rehabilitation protocols, operative repair of acute Achilles tendon ruptures is a reliable treatment for active patients.     

改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂

目的探讨改良Bosworth术联合应用可吸收防粘连膜治疗陈旧性跟腱断裂的效果。方法14例陈旧性跟腱断裂病例采用改良Bosworth法重建后,可吸收防粘连膜包绕肌腱的术式予以治疗。跟腱缺损范围3．6～10cm,平均6.3cm。结果平均随访29个月。按Arner-Lindholm疗效评定标准评估,优12例,良2例。结论改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂临床疗效满意,具有良好的应用前景。     

跟腱再断裂的修复重建

 目的 总结跟腱再断裂的原因, 探讨野V-Y冶推进瓣及长屈肌腱(flexor hallucis longus, FHL)转位修复重建跟腱再断裂的适应证、疗效及其相关并发症。方法 2006年 3月至 2010年 1月手 术修复重建跟腱再断裂患者 16例 16足, 男 12例, 女 4例;年龄 35~72岁, 平均 50.9岁。再断裂距初次 手术时间为 6~49周(平均 21.8周), 随访时间 6~52个月(平均 27.5个月)。充分清除断端瘢痕及坏死组 织4例断端缺损4 cm者采用 FHL转位修 复重建。结合患者病史、康复方式及再次手术术中所见跟腱形态, 分析其发生再断裂原因。观察术后局 部外观及功能恢复情况, 并采用美国足踝外科协会踝-后足评分(American Orthopaedic Foot &; Ankle Society-ankle and hindfoot score,AOFAS-AH)及 Leppilahti跟腱修复评分进行疗效评价。结果 跟腱再 断裂的原因主要为手术切口感染、术后跟腱愈合不良发生液化坏死、术后过早负重或活动不当致跌倒。 采用野V-Y冶推进瓣或 FHL转位修复跟腱再断裂术后局部外观及功能恢复良好, AOFAS-AH评分从术前 (70.2±8.5)分提高到(92.4±6.1)分;Leppilahti跟腱修复评分从术前(74.8±6.2)分提高到(91.7±4.8)分。踝 部 MRI显示跟腱部信号均匀, 无撕裂或积液表现。结论 跟腱再断裂后需彻底清创, 导致大范围缺损。 腓肠肌腱膜野V-Y冶推进瓣可修复4 cm的缺损, 术后踝足部功能外形恢复良好。     

血友病性跟腱挛缩症的外科治疗

背景：血友病性跟腱挛缩症是血友病的常见下肢合并症,可导致下肢不等长、活动受限等症状。在全面的围手术期凝血因子替代治疗下手术矫正跟腱挛缩可极大改善患者的生活质量。目的：探讨外科治疗血友病性跟腱挛缩症的围术期处理方法、术式选择及疗效。方法：回顾性分析1998年6月至2014年2月收治的血友病性跟腱挛缩患者15例（15足）,均为男性;年龄18~41岁,平均24.6岁;左侧7例,右侧8例。其中甲型血友病11例,乙型血友病4例。病程11~84个月,平均30.2个月。术前根据美国矫形足踝协会（AOFAS）评分为（41.2±20.1）分,简明健康调查量表（SF-36量表）评分总分为（41.4±17.7）分。入院后行凝血因子预试验,制定围术期凝血因子替代治疗方案,均行跟腱Z型延长术。结果：手术时间55~75 min,平均61 min;术中使用止血带,出血量均〈20 ml,围术期均未输异体血。术后14例手术切口Ⅰ期愈合,1例伤口裂开,经换药后3周愈合。术后无感染、下肢深静脉血栓形成、神经损伤等并发症发生。患者均获得随访,随访时间为6个月~15年5个月,平均21个月。术后3个月及6个月随访时,AOFAS评分分别为（77.8±16.7）分和（79.8±12.5）分,SF-36量表评分分别为（73.6±13.8）分和（77.7±11.2）分,与术前相比均有统计学差异（P〈0.05）;术后3个月与术后6个月比较均无统计学差异（P〉0.05）。结论：手术治疗可以纠正血友病性跟腱挛缩患者的马蹄足畸形,改善足部负重及行走功能。术前行凝血因子预试验、围手术期行凝血因子替代治疗可降低术后大出血的发生率。     

长屈肌腱转位手术治疗老年跟腱断裂的疗效分析

背景：慢性跟腱疾病发展到后期往往需要行肌腱转位治疗,长屈肌腱转位手术是常用的治疗方式。但老年患者的功能恢复、生活方式有别于其他人群。目的：探讨长屈肌腱转位手术治疗老年人跟腱断裂的临床效果。方法：回顾性分析2007年9月至2012年7月在我院行长屈肌腱转位手术的老年患者的病例资料（＞60岁）。共14例（16足）,男女各7例,年龄60~83岁,平均67.1岁。2例女性患者为双侧跟腱断裂同时行手术修补,均采用单切口长屈肌腱转位替代跟腱疗法。分别评估患者术前与术后美国足踝外科协会踝-后足评分（AOFAS-AH）,美国足踝外科协会趾-跖趾-趾间关节评分（AOFAS-MTPIP）,视觉模拟法（VAS）疼痛评分,跟腱断裂评分（ATRS）及手术相关并发症情况。最后进行统计学比较,评价患者足踝部功能恢复情况及患者满意情况。结果：14例患者术后获得21~67个月随访。AOFAS-AH评分从术前（68.2±6.2）分提高到术后的（93.2±5.3）分;AOFAS-MTPIP评分术前为（94.2±2.9）分,术后为（95.1±3.2）分;VAS评分术前（5.1±1.4）分,术后为（1.0±0.7）分;ARTS评分从术前（52.7±9.3）分提高到术后（86.3±10.3）分。16足术后均未出现伤口感染等手术并发症,也未在围手术期出现肺部感染、深静脉血栓等其他并发症。结论：长屈肌腱转位手术在老年人中的应用不但具有很好的手术疗效,并且安全性较高。     

Mechanical Properties of Reconstructed Achilles Tendon with Transfer of Peroneus Brevis or Flexor Hallucis Longus Tendon

Treatment of chronic Achilles tendon ruptures can be technically difficult because of tendon retraction, atrophy, and short distal stumps. Surgical repair of chronic Achilles tendon ruptures focuses on local and free tendon transfers, as well as reconstruction with allografts or synthetic materials. This study examined the in vitro mechanical properties of a reconstructed Achilles tendon with the peroneus brevis or the flexor hallucis longus tendons in a human cadaver model. The tendons were harvested from 17 fresh-frozen human cadavers, and the same techniques were used for all of the model reconstructions. Biomechanical measurements included the failure load, stiffness, energy-to-peak load, and mode of failure. The mean failure load was significantly higher in the peroneus brevis group (P = .036), and there was no significant difference in stiffness and energy-to-peak load between the peroneus brevis and flexor hallucis longus groups. In every case, the mode of failure involved the tendon graft pulling through either the distal or proximal stump of the Achilles tendon. The greater failure loads observed with the use of peroneus brevis may not be clinically relevant, however, because of the magnitude of the peak loads observed in the cadaveric model. The present study supports the use of either peroneus brevis or flexor hallucis longus for reconstruction of chronic Achilles tendon ruptures and indicates the need for surgeons to carefully reinforce the attachment of the transferred tendon grafts to the stumps of the Achilles tendon to prevent pullout.     

Evolution of the Achilles tendon: The athlete's Achilles heel?

The Achilles tendon is believed to have first developed two million years ago enabling humans to run twice as fast. However if the Achilles tendon is so important in terms of evolution, then why is this tendon so prone to injury – especially for those more active like athletes. The Achilles tendon had an integral role in evolving apes from a herbivorous diet to early humans who started hunting for food over longer distances, resulting in bipedal locomotion. Evolutionary advantages of the Achilles tendon includes it being the strongest tendon in the body, having an energy-saving mechanism for fast locomotion, allows humans to jump and run, and additionally is a spring and shock absorber during gait. Considering these benefits it is therefore not surprising that studies have shown athletes have thicker Achilles tendons than subjects who are less active. However, contradictory to these findings that show the importance of the Achilles tendon for athletes, it is well known that obtaining an Achilles tendon injury for an athlete can be career-altering. A disadvantage of the Achilles tendon is that the aetiology of its pathology is complicated. Achilles tendon ruptures are believed to be caused by overloading the tensed tendon, like during sports. However studies have also shown athlete Achilles tendon ruptures to have degenerative changes in the tendon. Other flaws of the Achilles tendon are its non-uniform vascularity and incomplete repair system which may suggest the Achilles tendon is on the edge of evolution. Research has shown that there is a genetic influence on the predisposition a person has towards Achilles tendon injuries. So if this tendon is here to stay in our anatomy, and it probably is due to the slow rate of evolution in humans, research in genetic modification could be used to decrease athletes’ predisposition to Achilles tendinopathy.