腱旁小切口Krackow法缝合急性闭合性跟腱断裂

[目的]研究腱旁小切口Krackow法缝合急性闭合性跟腱断裂的效果。[方法] 2015年8月～2018年6月收治的确诊为急性闭合性跟腱断裂患者92例。其中,44例采用腱旁有限小切口Krackow法缝合,48例行常规开放缝合法。[结果]两组患者均顺利完成手术,小切口组患者手术切口长度、手术时间、术中出血量均显著优于常规组(P0.05)。末次随访时,小切口组患者AOFAS足踝评分明显优于常规组(P0.05)。按Arner-lindholm评定标准,小切口组优良率为97.73%。常规组为77.08%,差异具有统计学意义(P0.05)。[结论]相比常规切开修复,腱旁有限小切口Krackow法缝合治疗急性闭合性跟腱断裂具有安全、微创、高效的优点。     

闭合性跟腱断裂微创腱皮缝合的远期疗效观察

[目的]通过对长期疗效和可能并发症的观察,介绍并评价微创腱皮缝合术治疗急性闭合性跟腱断裂的临床效果。[方法]自1996年1月～2005年4月间,随机选取跟腱断裂的患者28名,经术前查体和MRI证实,均为新鲜完全性闭合性跟腱断裂。首先微创暴露跟腱断端,清除断端的瘢痕和血凝块,梳理对合两断端,在皮外经跟腱断端以远健康部位做减张缝合。患者常规术后随访,平均随访4年（1～7年）。随访包括常规的临床评价和术后MRI检查,并应用Arner-Lindholm疗效评定标准对术后效果进行评定。其中2例未能按时随访。[结果]对所有26例患者,按Arner-Lindholm疗效评定标准进行评定,其中优19例,良6例,差1例,优良率为97%,无感染发生,再断裂1例,为长期局部类固醇封闭患者。术后MRI显示,全部患者的跟腱得到了良好的修复,跟腱断端连续性好,疤痕小。[结论]通过长期随访,微创腱皮缝合是一种修复急性闭合性跟腱断裂较好的方法,具有创伤小,有效保护跟腱血运,术后并发症少的优点。     

经通道辅助缝合系统微创手术治疗急性闭合性跟腱断裂疗效分析

目的探讨经通道辅助缝合系统微创手术治疗急性闭合性跟腱断裂的临床疗效。方法纳入自2016-04—2018-04诊治的32例急性闭合性跟腱断裂,14例采用经通道辅助缝合系统微创手术治疗(微创组),18例行常规跟腱吻合修复手术治疗(常规组)。比较2组切口长度、手术时间、术中出血量、住院时间、并发症发生率,以及术后3、12个月足踝功能AOFAS评分。结果 32例均获得随访,随访时间平均21.7(12～36)个月。与常规组比较,微创组切口长度更短,手术时间缩短,术中出血量减少,住院时间也缩短,并发症发生率更低,差异有统计学意义(P 0.05)。微创组与常规组术后3、12个月足踝功能AOFAS评分差异无统计学意义(P0.05)。结论经通道辅助缝合系统微创手术治疗急性闭合性跟腱断裂切口长度短、创伤小,能有效缩短手术时间及住院时间,减少术中出血量,降低术后并发症发生率。     

小切口加腱皮减张缝合法治疗闭合性跟腱断裂22例

目的 探讨急性闭合性跟腱断裂一种新的治疗方法。方法 从1994年～2001年8月，采用小切口加腱皮减rner-Lindholm疗效评定标准，优19例(86．4％)，良3例(13．6％)，优良率达100％。结论 小切口加腱皮减张缝合法治疗急性闭合性跟腱断裂，能有效分散断端张力，有效保护断端血供，创伤小，伤口无异物反应，再断裂及感染机会少，功能恢复快，是治疗急性闭合性跟腱断裂的较好方法。     

微创与常规切口治疗新鲜跟腱断裂

目的：通过与传统常规切口缝合法比较,探讨微创小切口缝合法修复新鲜闭合性跟腱断裂的疗效。方法：分别采用微创小切口缝合法与常规切口缝合法治疗40例新鲜跟腱断裂患者,常规切口组（A组）22例,微创小切口组18例（B组）,术后应用相同康复程序,采用临床客观检查及美国足踝外科协会评分进行评价。结果：术后随访1～6年,A组切口感染率13.6%,B组未发生切口感染;A组平均切口长度较B组长5.5 cm,A组AOFAS评分为91分,B组为97分（均P＜0.05）。结论：微创小切口缝合法修复新鲜跟腱断裂,效果优于常规切口技术。     

导针引导微创缝合治疗急性闭合性跟腱断裂

目的探讨应用硬膜外穿刺导针引导,微创小切口缝合急性闭合性跟腱断裂的手术疗效。方法急性跟腱断裂病人29例,根据治疗方式不同分为导针引导微创小切口缝合组16例,传统开放缝合组13例。病人于伤后5小时～5天内行跟腱手术修补,术后行个性化长腿及短腿石膏固定,功能锻炼1～2个月;所有病人随访至少1年;比较病人手术时间,术后并发症(切口感染,腓肠神经损伤,跟腱再断裂)和术前、术后1年美国矫形足踝协会评分(AOFAS)及跟腱完全断裂评分(ATRS)。结果传统开放缝合组手术时间为(48.91±12.56)分钟,微创组(41.78±9.56)分钟,两者比较差异无统计学意义(P0.05);两组均未出现术后腓肠神经损伤及跟腱再断裂情况,传统组在随访期间出现3例皮肤感染坏死/延迟愈合;截至随访结束,两组病人术前术后AOFAS评分比较,差异有统计学意义(P0.05),但两组间术后AOFAS及ATRS评分比较差异无统计学意义(P0.05)。结论经导针引导下微创治疗跟腱断裂手术时间略长,但与常规手术比较,能有效避免术后并发症。     

微创手术治疗急性闭合性跟腱断裂

[目的]分析微创手术治疗急性闭合性跟腱断裂的临床效果。[方法]选取2015年5月～2018年4月收治的60例急性闭合性跟腱断裂患者,根据手术方法分为两组,微创组(小切口微创手术,n=30)和开放组(开放手术,n=30),对比两组患者手术效果。[结果]微创组手术时间、住院时间、恢复时间均低于开放组(P0.05);微创组治疗后,VAS疼痛评分、AOFAS评分(由美国足踝外科学会制定)均优于开放组(P0.05);微创组与开放组术后并发症发生率(3.33%VS 23.33%)比较差异具有统计学意义(P0.05)。[结论]微创手术治疗效果显著,在急性闭合性跟腱断裂患者治疗中发挥重要作用,可降低疼痛感,减少并发症,促进患者恢复,具有临床推广价值。     

两种缝合术治疗急性闭合性跟腱断裂的比较研究

目的通过两种不同的缝合技术对于急性闭合性跟腱断裂的治疗,观察比较两种技术的疗效。方法将58例急性闭合性跟腱断裂患者随机分为A、B两组,A组采用腓肠肌腱瓣翻转加固术,B组采用改良Kessler缝合术,术后3、6、12个月采用北京大学第三医院制定的跟腱断裂修补术后的评估系统进行评定。结果所有患者均获得随访,随访时间最短12~36个月,平均随访18个月。术后3个月两组比较,差异无统计学意义(P0.05),术后6个月、12个月,A组疗效优于B组,两组比较差异有统计学意义(P0.05)。结论腓肠肌腱瓣翻转加固术为治疗急性闭合性跟腱断裂更有效的方法。     

塑型卵圆钳经皮缝合与切开缝合治疗新鲜闭合性跟腱断裂的对照研究

目的 比较塑型卵圆钳经皮微创缝合技术和切开缝合技术治疗新鲜闭合性跟腱断裂的临床疗效。方法 回顾性研究自2014年1月至2016年10月收治的73例新鲜闭合性跟腱断裂病人,最终入组共70例,根据手术方式的不同分为两组：微创组（36例）借助自制的塑型卵圆钳,通过小切口经皮缝合修复跟腱;常规组（34例）采用常规跟腱内侧纵行切口,连续锁边缝合修复跟腱。记录两组手术时间、术中出血量、术后并发症、恢复至伤前运动水平的时间、末次随访时的美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分,术后1年复查MRI评估跟腱修复状况。结果 两组病人获得16~44个月（平均30个月）随访,其中微创组手术时间为（45.34±6.73） min,术中出血量为（15.12±4.11） ml;常规组手术时间为（69.33±13.44） min,术中出血量为（25.47±7.19） ml,两组比较,差异均有统计学意义（P均＜0.05）。微创组2例病人切口延迟愈合,2例出现线结刺激症状,1例腓肠神经损伤,1例于术后半年外伤后再断裂;常规组3例伤口浅表感染,2例出现深部感染,无腓肠神经损伤及跟腱再断裂。末次随访AOFAS评分：微创组为（95.81±2.35）分,常规组为（93.61±4.83）分;微创组有29例病人（21.0±4.7）周（20~24周）恢复至伤前运动水平,常规组有26例（23.0±3.5）周（21~31周）恢复至伤前运动水平;上述指标比较,差异均无统计学意义（P均＞0.05）。术后1年MRI均显示跟腱连续性完整,未观察到跟腱囊性变。结论 自制塑型卵圆钳经皮缝合技术修复新鲜闭合性跟腱断裂手术时间短,术后恢复更快,且并不增加跟腱再断裂发生率。     

急性闭合性跟腱断裂跟腱病理改变与超微结构研究

目的:探讨急性闭合性断裂跟腱组织形态学与超微结构变化.方法:回顾分析2015年1月至2019年1月采用跟腱微创缝合技术治疗的急性跟腱断裂患者35例,其中急性开放性跟腱断裂12例,男10例,女2例,年龄19～50(35.1±9.7)岁,受伤至手术时间2～8(5.6±1.8)h.急性闭合性跟腱断裂23例,男21例,女2例,...     

Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture

BackgroundTo compare the effectiveness of tenocutaneous suture and conventional Kessler suture techniques in treating acute closed Achilles tendon rupture.MethodsA total of 33 patients with acute closed Achilles tendon rupture who were admitted to our hospital from February 1998 to December 2008 underwent repair with either a tenocutaneous suture or Kessler suture technique. All patients were followed up for 1–5 years (mean, 3 years).ResultsAccording to the American Orthopaedic Foot and Ankle Society ankle–hindfoot scale, the excellence rate was 91% in the Kessler suture group and 98% in the tenocutaneous suture group, with a significant difference between groups.ConclusionOur tenocutaneous suture technique is an effective method for treating Achilles tendon rupture. It has certain advantages compared with the conventional incision method and is worthy of wide clinical application.     

改良经皮缝合法与开放缝合法修复新鲜闭合性跟腱断裂的疗效比较

目的通过与开放缝合法比较,探讨改良经皮缝合法修复新鲜闭合性跟腱断裂的疗效。方法 2006年1月-2009年10月,收治50例新鲜闭合性跟腱断裂患者,根据治疗方法不同分为两组,22例采用改良经皮缝合法治疗(改良组),术中于跟腱两侧平行各作5个孔,采用"之"字形方式缝合;28例采用Kesller缝合法治疗(常规组)。两组患者性别、年龄、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果常规组术后1例切口感染,1例跟腱再断裂,2例切口瘢痕挛缩;改良组患者切口均Ⅰ期愈合,无并发症发生。改良组手术时间为(38.7±6.6)min,明显短于常规组(52.3±6.9)min(t=—12.29,P=0.00);改良组术中失血量为(4.9±2.0)mL,显著低于常规组(40.7±7.1)mL(t=—25.20,P=0.00)。两组患者均获随访,随访时间2～3年,平均29.9个月。术后2年应用美国矫形足踝协会(AOFAS)评分标准评定,改良组为(99.6±1.0)分,常规组为(98.4±3.0)分,差异无统计学意义(t=1.66,P=0.10)。结论与开放缝合法比较,改良经皮缝合法具有手术操作简便、并发症少、踝关节功能恢复快等优点,是治疗新鲜闭合性跟腱断裂的较好选择之一。     

三种手术方法治疗新鲜跟腱断裂比较研究

目的比较传统切开跟腱吻合术、经皮微创跟腱吻合术以及应用跟腱吻合器有限切开术治疗新鲜闭合性跟腱断裂的疗效,为临床治疗方式的选择提供参考依据。方法 2007年12月-2010年3月将69例符合纳入标准的新鲜闭合性跟腱断裂患者随机分为3组,其中采用传统切开跟腱吻合术23例(传统切开组),经皮微创跟腱吻合术23例(经皮微创组),应用跟腱吻合器有限切开治疗23例(有限切开组)。3组患者性别、年龄、损伤机制、美国足踝外科协会(AOFAS)踝-后足评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果经皮微创组及有限切开组住院时间及失血量明显优于传统切开组(P<0.01)。术后传统切开组发生2例(8.7%)切口感染坏死,其余两组患者切口均Ⅰ期愈合;传统切开组术后腱旁组织并发症发生率高于其余两组(P<0.05)。经皮微创组及有限切开组各1例(4.3%)发生跟腱再断裂,传统切开组跟腱再断裂发生率(0)低于其余两组(P<0.05)。69例均获随访,随访时间12～18个月,平均14.9个月。术后12个月3组踝关节AOFAS评分均>90分,较同组术前显著改善(P<0.05),组间比较差异无统计学意义(P>0.05)。结论 3种手术方式均能有效治疗新鲜跟腱断裂,有限切开或经皮微创手术方法创伤小,伤口愈合好,住院时间少,术后腱旁组织并发症少,但跟腱再断裂风险增加。     

Open versus closed repair of the Achilles tendon: an experimental animal study.

This experimental animal study compared the healing patterns between open and closed treatments of Achilles tendon tenotomies. Twenty-four male New Zealand rabbits underwent tenotomy of the left Achilles tendon and were randomized into two groups, treated with either open surgical repair or closed management. After the death of the animal, the retrieved tendons were submitted for biomechanical and histological testing. The total elongation of the open treatment group was 9.5+/-1.0 mm compared with 21.2+/-3.4 mm for the closed treatment group (P = 0.008), and the regain of stiffness was 67.4+/-2.0% and 48.9+/-5.3%, respectively (P = 0.132). Histological evaluation demonstrated similar healing patterns in both groups.     

Treatment of Acute and Closed Achilles Tendon Ruptures by Minimally Invasive Tenocutaneous Suturing

Achilles tendon rupture is a common injury, and its complications can impair function. Numerous operations have been described for reconstructing the ruptured tendon, but these methods can compromise the microcirculation in the tendon and can seriously damage healing of the tendon. Suturing with a minimally invasive tenocutaneous technique soon after the rupture and systematic functional exercise can greatly reduce the possibility of complications. From June 1996 to February 2007, we treated 20 patients (14 males), who ranged in age from 21 to 66 years old, with this method. After follow-up period of 1 to 7 years, the mean American Orthopedic Foot and Ankle Society Ankle Hindfoot score was 95 (range 90 to 98), and the maximum length of postoperative scarring was 3 cm. One patient again ruptured his Achilles tendon 1 year after surgery in an accident; however, after 10 months, the repaired tendon was still intact. In another patient, the nervus suralis was damaged during surgery by piercing the tension suture at the near end, causing postoperative numbness and swelling. The tension suture was quickly removed, and the patient recovered well with conservative treatment. No large irregular scars, such as those sustained during immobilization, were present over the Achilles tendon. Minimally invasive percutaneous suturing can restore the original length and continuity of the Achilles tendon, is minimally invasive, and results in fewer postoperative complications than other methods.     

Atraumatic Spontaneous Achilles Tendon Rupture in Patients Receiving Oral Corticosteroids Treated With the Modified Side-Locking Loop Suture Technique

Atraumatic spontaneous Achilles tendon ruptures sometimes occur in patients receiving oral corticosteroids. In general, these cases are treated surgically; however, delayed postoperative management can lead to impaired activities of daily living. The modified side-locking loop suture (SLLS) technique is a useful suture method for safe and early active mobilization. Three cases of spontaneous Achilles tendon ruptures were treated with the modified SLLS technique with good clinical results. The modified SLLS technique is a useful method with a short rehabilitation period for treating atraumatic spontaneous Achilles tendon rupture in patients undergoing corticosteroid therapy.     

Use of mesenchymal stem cells in a collagen matrix for achilles tendon repair

This investigation tested the hypothesis that delivering mesenchymal stem cell-seeded implants to a tendon gap model results in significantly improved repair biomechanics. Cultured, autologous, marrowderived mesenchymal stem cells were suspended in a collagen gel delivery vehicle; the cell-gel composite was subsequently contracted onto a pretensioned suture. The resulting tissue prosthesis was then implanted into a 1-cm-long gap defect in the rabbit Achilles tendon. Identical procedures were performed on the contralateral tendon, but only the suture material was implanted. The tendon-implant constructs were evaluated 4, 8, and 12 weeks later by biomechanical and histological criteria. Significantly greater load-related structural and material properties were seen at all time intervals in the mesenchymal stem cell-treated tendons than in the contralateral, treated control repairs (p < 0.05), which contained suture alone with natural cell recruitment. The values were typically twice those for the control tissues at each time interval. Load-related material properties for the treated tissues also increased significantly over time (p < 0.05). The treated tissues had a significantly larger cross-sectional area (p < 0.05), and their collagen fibers appeared to be better aligned than those in the matched controls. The results indicate that delivering mesenchymal stem cell-contracted, organized collagen implants to large tendon defects can significantly improve the biomechanics, structure, and probably the function of the tendon after injury.     

Interlocking horizontal mattress suture versus Kakiuchi technique in repair of Achilles tendon rupture: a biomechanical study

Background

In recent years, the type of surgical treatment for Achilles tendon rupture has been the subject of controversial debate. This biomechanical study evaluates for the first time in literature the ultimate failure load (UFL) of interlocking horizontal mattress (IHM) suture as compared with Kakiuchi suture in Achilles tendon rupture. The hypothesis is that IHM suture can be performed also for Achilles tendon rupture and ensures higher resistance compared with the traditional Kakiuchi suture.

Materials and methods

Twenty fresh bovine Achilles tendons were obtained. Ten preparations were randomly assigned to each of two different groups: group A (10 specimens) sutured by IHM technique, and group B (10 specimens) sutured by Kakiuchi technique. Each construct was mounted and fixed on a tensile testing machine. Static preconditioning of 50 N was applied for 5 min as initial tensioning to stabilize the mechanical properties of the graft, then a load to failure test was performed at crosshead speed of 500 mm/min.

Results

Ten specimens were tested for each group. The mean UFL was 228.6 ± 98.6 N in the IHM suture group and 96.57 ± 80.1 N in the Kakiuchi suture group. Statistical analysis showed a significant difference (p < 0.05) with better UFL in the IHM group. In both groups, the failure mode registered in each specimen was suture breakage (rupture of suture thread).

Conclusions

IHM suture achieved better UFL compared with Kakiuchi suture in an animal model of Achilles tendon repair. These results seem to support IHM as a valid option in Achilles tendon rupture.