TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂

目的 探讨TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂的临床疗效.方法 采用TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂患者11例,术中用改良Kessler法对位缝合跟腱断端,再用2枚TwinFix带线锚钉辅助固定断裂跟腱.术后予患侧下肢屈膝90°、踝跖屈30°位长腿石膏托固定,3周后改踝跖屈石膏托固定.结果 11例均获随访,时间3～18个月.患者均未发生切口延期愈合、感染、皮肤坏死和跟腱再断裂等并发症.采用Arner-Lindholm评分标准评价疗效:优7例,良3例,差1例.结论 TwinFix带线锚钉辅助改良Kessler法手术操作简便,是修补陈旧性跟腱断裂的有效方法.     

带线锚钉与单纯缝线吻合治疗急性跟腱断裂

<正>2013年4月～2016年9月,我科采用带线锚钉或单纯缝线吻合断端治疗24例急性跟腱断裂患者,疗效良好,报道如下。1材料与方法1. 1病例资料本组24例,男21例,女3例,年龄23～60岁。左侧10例,右侧14例。闭合伤21例,开放伤3例。8例跟腱断裂距止点3 cm,断端均不规则; 16例跟腱断裂距止点3～6 cm。带线锚钉+丝线Kessler法缝合9例,单纯缝线吻合15例。受伤至手术时间1～21 d,20例在1周以内,4例超过1周。1. 2治疗方法全身麻醉或腰硬联合     

带线锚钉锁边缝合桥接修复急性闭合性跟腱远端断裂的临床疗效

目的：探讨带线锚钉微创治疗急性闭合性跟腱远端断裂的临床疗效。方法：自2019年7月至2021年3月,采用微创带线锚钉锁边缝合桥接修复技术治疗20例急性闭合性跟腱远端断裂患者,其中男18例,女2例;年龄19~52(40.0±9.0)岁。观察其并发症情况,并于术前和术后1年采用美国足踝外科协会踝与后足功能评分系统(American Orthopaedic Foot&Ankle Society,AOFAS)评价踝关节功能恢复情况。结果：所有患者获得随访,时间6~18(12.0±3.2)个月。所有患者切口Ⅰ期愈合,无感染及皮肤坏死发生,未出现腓肠神经损伤及下肢深静脉血栓形成,无足跟疼痛和跟腱再断裂发生,踝关节屈伸活动良好。AOFAS评分由术前的(59.0±4.3)分提高至术后1年的(95.1±2.6)分。结论：带线锚钉锁边缝合桥接修复急性闭合性跟腱远端断裂疗效确切,可降低跟腱再断裂、神经损伤、皮肤坏死等并发症,具有手术创伤小、吻合方法可靠、功能恢复好等优点,是治疗急性闭合性跟腱远端断裂的理想方法。     

Krackow锁定缝合法联合改良Kessler缝合法治疗急性闭合性跟腱体部断裂

目的 探讨Krackow锁定缝合法联合改良Kessler缝合法治疗急性闭合性跟腱体部断裂的疗效。方法 2020年1月～2022年1月我科对162例急性闭合性跟腱体部断裂采用Krackow锁定缝合法联合改良Kessler缝合法手术治疗,术后采用相同的康复计划。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分和跟腱完全断裂评分(Achilles Tendon Total Rupture Score, ATRS)进行功能评价。结果 手术时间24～40 min[(31.9±4.6)min]。切口均为一期愈合,无感染、腓肠神经损伤。2例并发症：下肢深静脉血栓1例,意外导致跟腱再断裂1例。踝关节屈伸活动度恢复时间为4～12周[(7.6±1.9)周],患侧单足提踵恢复时间为10～18周[(13.3±1.8)周],快走或慢跑恢复时间为14～26周[(19.1±1.8)周]。162例随访14～25个月,平均19.0月。AOFAS踝-后足评分由术前(54.4±4.4)分提高到末次随访(98.0±4.0)分(t=-104...     

Kessler缝合联合富血小板血浆治疗跟腱断裂

[目的]探讨Kessler缝合联合富血小板血浆(platelet rich plasma,PRP)治疗跟腱断裂的临床结果.[方法]回顾性分析2017年1月-2019年10月本院收治的102例跟腱断裂患者临床资料.依据术前医患沟通结果分为两组,其中50例单纯采用Kessler缝合法治疗(n-PRP组),52例采用Kess...     

带线锚钉修复跟腱断裂

<正>2012年11月~2014年1月,我科应用以带线锚钉修复13例跟腱断裂患者,疗效满意,报道如下。1材料与方法1.1病例资料本组13例,男10例,女3例,年龄16~55岁。开放损伤4例均急诊手术。闭合损伤9例,受伤距手术时间1~6 d。1.2治疗方法硬膜外麻醉。开放伤口彻底清创,取原伤口适当延长切口。闭合损伤在跟腱内侧缘跟骨结节以近作     

带线锚钉跟腱止点重建治疗闭合性跟腱断裂相关问题探讨

目的:探讨闭合性跟腱断裂的手术方法。方法:采用闭合性跟腱断裂带线锚钉跟腱止点重建9例。结果:随访时间6个月～2年,按Arner-Lindholm法评定标准评定,优8例,良l例。结论:带线锚钉Krackow缝合跟腱止点重建操作简单、创伤小,对跟腱断端固定牢固,效果良好。     

Kessler与改良Krackow缝合法修复闭合性跟腱断裂的比较研究

目的探究与分析Kessler与改良Krackow缝合法在修复闭合性跟腱断裂的作用。方法选取自2016-07—2017-07收治的36例闭合性跟腱断裂患者,采取随机数字表法分为Kessler组与改良Krackow组,每组各18例,对比2组患者修复闭合性跟腱断裂患者围术期指标、并发症发生率、术后9个月临床疗效、下肢功能及生活质量评分。结果 2组的手术时间、术中出血量相比,差异无统计学意义(P0.05)。改良Krackow组与Kessler组相比于切口愈合不良、切口感染、腓肠神经损伤、跟腱二次断裂、术后粘连的发生率均较低,差异有统计学意义(P 0.05)。改良Krackow组与Kessler组相比术后9个月的临床疗效优良率及满意度评分较高,差异有统计学意义(P 0.05)。改良Krackow组与Kessler组治疗后与治疗前相比下肢功能及生活质量评分较高,改良Krackow组治疗后与Kessler组治疗后相比上述评分升高更加显著,差异具有统计学意义(P 0.05)。结论改良Krackow缝合法相比于Kessler缝合法修复闭合性跟腱断裂患者的临床疗效更加满意,随访期间下肢功能及生活质量改善更加显著。     

带线锚钉修复重建跟腱止点断裂的临床观察

跟腱断裂是临床常见的肌腱损伤之一,由于感染及再断裂发生率较高,在治疗上仍有一定困难.笔者自2010年5月～2011年5月采用Fastin带线锚钉修复跟腱止点断裂7例,取得较好疗效.现报告如下. 1 临床资料 1.1一般资料本组共7例,男4例,女3例;年龄19～43岁,平均32岁.     

缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂

目的探讨缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂的临床疗效。方法自2007-11—2012-09采用缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂29例,术后6个月依据Arner-Lindholm评分和AOFAS评分标准评定疗效。结果本组手术时间25~52 min,平均52 min。切口均一期愈合。所有患者均获得平均11.3(7~19)个月随访,无跟腱再次断裂、跟腱粘连等并发症发生。随访至术后6个月时,按照Arner-Lindholm评分标准评定临床疗效:优20例,良9例;采用美国足踝外科学会(AOFAS)踝-足评分标准进行功能评价:优19例,良10例,平均92.3分。结论缝合锚钉Krackow缝合法治疗新鲜闭合性跟腱断裂具有操作简单、肌腱修复可靠、踝关节功能恢复好的优点。     

Biomechanic comparison of the Teno Fix tendon repair device with the cruciate and modified Kessler techniques

PURPOSE: To compare the mechanical behavior of a novel internal tendon repair device with commonly used 2-strand and 4-strand repair techniques for zone II flexor tendon lacerations. METHODS: Thirty cadaveric flexor digitorum profundus tendons were randomized to 1 of 3 core sutures: (1) cruciate locked 4-strand technique, (2) modified Kessler 2-strand core suture technique, or (3) Teno Fix multifilament wire tendon repair device. Each repair was tested in the load control setting on a Instron controller coupled to an MTS materials testing machine load frame by using an incremental cyclic linear loading protocol. A differential variable reluctance transducer was used to record displacement across the repair site. Cyclic force (n-cycles) to 1-mm gap and repair failure was recorded using serial digital photography. RESULTS: There was no significant difference in differential variable reluctance transducer displacement between the cruciate, modified Kessler, and Teno Fix repairs. The cruciate repair had greater resistance to visual 1-mm repair-site gap formation and repair-site failure when compared with the Kessler and Teno Fix repairs. No significant difference was found between the modified Kessler repair and the Teno Fix repair. In all specimens, the epitenon suture failed before the core suture. Repair failure occurred by suture rupture in the 7 cruciate specimens that failed, with evidence of gap formation before failure. Seven of 10 modified Kessler repairs failed by suture rupture. All of the Teno Fix repairs failed by pullout of the metal anchor. CONCLUSIONS: The Teno Fix repair system did not confer a mechanical advantage over the locked cruciate or modified Kessler suture techniques for zone II lacerations in cadaveric flexor tendons during cyclic loading in a linear testing model. This information may help to define safe boundaries for postoperative rehabilitation when using this internal tendon repair device.     

两种方法治疗新鲜闭合跟腱断裂

目的 比较跟腱断裂通道微创修复和传统开放切口直视下修复治疗新鲜闭合跟腱断裂的疗效.方法 将43例新鲜闭合跟腱断裂患者根据治疗方法 不同分为微创组(采用跟腱断裂通道微创修复术治疗,25例)和传统组(采用传统开放切口直视下修复术治疗,18例).比较两组切口长度、手术时间、切口愈合时间、术后并发症、疼痛评分及踝关节功能评分....     

Comparison of pullout button versus suture anchor for zone I flexor tendon repair

PURPOSE: To evaluate the clinical outcome after repair of zone I flexor tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx. METHODS: Between 1998 and 2002 we treated 26 consecutive zone I flexor tendon injuries. Thirteen patients had repairs from 1998 to 2000 using a modified pullout button technique (group A) and 13 patients had repair using suture anchors placed in the distal phalanx (group B). Patient characteristics were similar for both groups. The same postoperative flexor tendon rehabilitation protocol and follow-up schedule were used for both groups. Evaluation included range of motion, sensibility and grip strength, failure, complications, and return to work. The Student t test was used to determine significant differences. RESULTS: All patients completed 1 year of follow-up evaluation. There were 2 infections in group A that resolved with oral antibiotics and no infections in group B. There were no tendon repair failures and no repeat surgeries in either group. At final follow-up evaluation there were no statistically significant differences for the following end points: sensibility (Semmes-Weinstein monofilament testing and 2-point discrimination), active range of motion (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined motion), flexion contracture (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined contracture), and grip strength (injured tendon as a percent of the contralateral uninjured tendon). The suture anchor group had a statistically significant improvement for time to return to work. CONCLUSIONS: There was no significant difference in the clinical outcome after flexor tendon repair using either suture anchors or the pullout button technique. A significant improvement was found for time to return to work for repairs using the suture anchor technique. Flexor tendon repair can be achieved using suture anchors placed in the distal phalanx, thereby avoiding the potential morbidity associated with the pullout button technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.     

吻合口无结Kessler缝合法修复指屈肌腱的疗效观察

目的通过与传统Kessler缝合法比较,分析吻合口无结Kessler缝合法修复指屈肌腱的疗效及优势。方法回顾分析2005年2月-2010年2月采用吻合口无结Kessler缝合法治疗的122例163指243根指屈肌腱断裂患者临床资料(试验组),术中一期显微缝合指屈肌腱,修复腱外膜、腱鞘及腱周组织,应用透明质酸钠充填治疗。并与2001年2月-2005年2月采用传统Kessler缝合法治疗的96例130指186根指屈肌腱断裂患者(对照组)临床资料进行比较。两组患者性别、年龄、损伤原因、损伤部位、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后3周内采用Kleinert橡皮筋牵引疗法(动态支具保护),并于24 h后开始手指功能锻炼。结果术后试验组2例、对照组5例切口发生感染,经换药后2周愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6～14个月,平均9个月。术后6个月手指功能采用主动活动度(total active movement,TAM)法评定,试验组TAM为(192.0±13.1)°;其中获优54例,良58例,中8例,差2例,优良率为92%。对照组TAM为(170.0±15.2)°;其中获优23例,良30例,中22例,差21例,优良率为55%。两组TAM比较,差异有统计学意义(P<0.01)。结论吻合口无结Kessler缝合法治疗指屈肌腱断裂,辅以腱外膜、腱鞘及腱周组织修复后,手指功能恢复优于传统Kessler缝合法,但远期疗效仍需进一步观察。     

Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty

Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.     

应用(足母) 长屈肌腱加用跖肌腱加固重建陈旧性跟腱断裂

1999年6月-2004年3月采用长屈肌腱(FHL)加用跖肌腱加固治疗陈旧性跟腱断裂13例,现报告如下。1临床资料本组13例,男10例,女3例;年龄23~57岁,平均37·4岁;左侧8例,右侧5例;病程28~147d,平均78d。致伤原因:运动伤11例,切割伤2例。4例经手术修复后再断裂。伤后未处理1例。临床表现:13例均主诉踝跖屈提踵无力,其中8例足跟痛,跛行。体检:跟腱断裂处凹陷,Thompsom试验9例阳性,3例可疑,1例阴性。对可疑者行MRI检查。2手术方法手术采用硬膜外麻醉,俯卧,在气压止血带下进行。沿跟腱内侧S形切口,显露跟腱断端及跖肌腱。术中见残端均为瘢痕组织,充…     

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。     

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.